Richard Hyer

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – Circulating tumor necrosis factor appears to play a role in the cognitive dysfunction called "chemo brain" that some women experience after receiving chemotherapy as part of their primary treatment for newly diagnosed breast cancer.

Preliminary data on 93 women in a prospective observational cohort study show that women who underwent chemotherapy had higher levels of circulating tumor necrosis factor (TNF) than did similar women who had not received chemotherapy as part of their primary treatment.

The chemotherapy group also started the study with worse quality of life and poorer cognitive function, compared with patients who did not have chemotherapy before enrolling in the study. None of the women had started endocrine therapy at that point.

"These effects are specific to TNF and were not associated with other biomarkers of inflammation studied," Dr. Patricia A. Ganz reported at the annual meeting of the American Society of Clinical Oncology.

TNF may, therefore, represent a biologic target for pharmacologic therapy, as well as a biomarker that could help identify patients at increased risk for so-called "chemo brain," cognitive complaints during adjuvant chemotherapy that can persist for years afterward in up to 25% of breast cancer survivors, according to Dr. Ganz, director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The study is thought to be among the first to comprehensively examine the relationship between inflammatory markers and cognitive changes in breast cancer patients, she said. It was suggested in part by a study of doxorubicin exposure in an animal model, which found systemic increases in the proinflammatory cytokine TNF-alpha. This cytokine is able to cross the blood-brain barrier and accumulate in the central nervous system (Neurobiol. Dis. July 2006;23:127-39).

The current study enrolled 191 women within 3 months of completion of primary therapy (surgery, radiation, and/or chemotherapy), and prior to initiating endocrine therapy for recently diagnosed breast cancer. All women underwent comprehensive assessments at baseline, 6 months, and 12 months after enrollment. A subset of 16 women also participated in a PET scan substudy and had brain scans at baseline and 12 months later.

The longitudinal data reported by Dr. Ganz was based on the first 93 women with complete cytokine assessments: 49 women who received chemotherapy and 44 women who did not have chemotherapy as part of their primary treatment. Similar proportions of both groups had undergone mastectomy (28% overall) and radiotherapy (76% overall) during primary treatment; 72% of the total population went on to receive endocrine therapy. The women had a mean age of 51 years and were enrolled an average of 7 months after diagnosis of breast cancer.

At baseline, the postchemotherapy group reported significantly poorer quality of life and functioning on several standardized measures, including the SF36 physical and mental component summary scales, sleep, fatigue, and depression.

Self-reported measures of cognitive complaints, including the multidimensional Patients Assessment of Own Functioning Inventory, also suggested that they had greater memory impairments. A significant correlation was found between the memory subscale score in the chemotherapy group (correlation with log r = 0.33, P = .05).

Fasting blood specimens were tested for four inflammatory markers: interleukin-1 receptor antagonist, interleukin-6, C-reactive protein, and soluble TNF receptor type II (sTNFRII), which provides a stable assessment of TNF-alpha activity.

Only sTNFRII was significantly increased in the chemotherapy-treated group (2,492.5 pg/mL vs. 2,115.6 pg/mL in the other patients, P = .007). Over the course of the year, it decreased to the point where the difference between groups was no longer significant.

In the 16 patients with complete PET scan data, soluble TNF receptor level at baseline was negatively correlated with metabolic activity in the inferior frontal gyrus in chemotherapy-treated patients (P = .04). Patients with higher levels of TNF receptor had lower levels of metabolic activity. This also improved over 12 months.

Finally, genetic analysis suggests that the GG allele of the TNF-alpha 308 single nucleotide polymorphism was associated with more cognitive complaints. It may enhance the patient’s vulnerability to cognitive complaints and cognitive dysfunction.

Discussant Karen Mustian, Ph.D., of the University of Rochester (N.Y.) said, "The strengths of this study include its prospective longitudinal design as well as the examination of potential biological mechanisms, including inflammation, genetic polymorphisms, and cerebral function."

She described examination of biomarkers and mechanisms as important in supportive care research, and expressed optimism that this type of research has only just begun.

The study was funded by the National Cancer Institute and the Breast Cancer Research Foundation. Dr. Ganz and Dr. Mustian said they had no relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The quality of care that older cancer survivors receive for comorbid conditions such as diabetes and heart failure varies by tumor type, according to a retrospective, cross-sectional analysis of database records for more than 25,000 people.

Colorectal cancer survivors fared the worst of three tumor cohorts studied. Compared with a control group of cancer-free patients, they were more likely to receive acute and chronic care that was subpar on a variety of measures, Claire Snyder, Ph.D., reported at the annual meeting of the American Society of Clinical Oncology.

Breast cancer survivors fared best, receiving equivalent acute and better chronic care than did cancer-free controls. Prostate cancer survivors came out somewhere in the middle, receiving worse acute care but better chronic care.

The study "does not explain why care was or was not provided," Dr. Snyder said, listing its limitations. She hopes to explore why survivor care varies by tumor type as well as possible relationships with cost, she added.

"The issue of comorbid-condition care in cancer survivors has been understudied. As our treatments improve and survivors live longer with a history of a cancer diagnosis, quality care for comorbid conditions takes on greater importance," said Dr. Snyder of Johns Hopkins University in Baltimore.

Cancer survivors’ health care needs include surveillance for recurrence and monitoring for the physical and psychosocial long-term and late effects of the disease and its treatment, she said. Their needs also include general primary and preventive care, and often care for comorbid conditions.

This study used data from the SEER (Surveillance, Epidemiology and End Results)–Medicare database, a cancer registry linked with Medicare claims data. The nation’s 17 SEER registries cover a representative sample of more than one-quarter of the U.S. population. Medicare claims data on noncancer controls who live in SEER regions were used for comparison.

The study population was diagnosed with locoregional breast, prostate, or colorectal cancer in 2004. They were at least 66 years old and were enrolled in fee-for-service Medicare during the study period. They had survived at least 3 years from diagnosis, and had no evidence of ongoing cancer treatment.

The 8,661 cancer survivors in the study were "frequency matched" with 17,322 cancer-free controls. Slightly more than half of the cancer group (4,559) had survived prostate cancer; 2,231 had survived colorectal cancer; and 1,871 survived breast cancer. The study period covered years 2 and 3 from day of diagnosis.

The final sample had a mean age of approximately 75 years; nearly two-thirds were men, and 85% were white. More than 88% in both case and control groups lived in an urban area.

There were 9 quality indicators for care of chronic conditions, and 19 for care of acute conditions. To calculate the percentage of survivors receiving appropriate care, investigators divided the number of cases and controls who received appropriate care by the number eligible for each indicator.

A summary analysis showed that among colorectal cancer survivors, there were four indicators of worse chronic care (chronic obstructive pulmonary disease visits, lipid monitoring after angina, diabetes eye exams, and diabetes monitoring), and three indicators of worse acute care (visits after acute MI and heart failure hospitalizations, and cholecystectomy), compared with controls.

Prostate cancer survivors had three indicators of worse acute care (ECG after heart failure, chest film after heart failure, and cholecystectomy), but two indicators of better chronic care (COPD and diabetes visits).

The breast cancer survivors did better on COPD and diabetes visits.

Quality indicators for the care of chronic conditions included the following:

• Visit frequency of 6 months for chronic stable angina, heart failure, COPD, and diabetes.

• Visit frequency of 12 months for transient ischemic attack (TIA).

• Cholesterol test every 6 months for patients with hypercholesterolemia who were hospitalized with acute MI.

• Lipid profile up to 1 year after initial diagnosis of angina.

• Yearly eye exam for diabetes patients.

• Glycosylated hemoglobin and fructosamine every 6 months for diabetes patients.

Quality indicators for the care of acute conditions included the following:

• Visits up to 4 weeks after discharge after hospitalization for acute MI, unstable angina, heart failure, cerebrovascular accident, TIA, diabetes, malignant or otherwise severe hypertension, or gastrointestinal bleed.

• Visits up to 2 weeks after discharge for patients hospitalized with depression.

• Visits up to 1 week after diagnosis of unstable angina (visit or hospitalization).

• ECG during emergency department visit for unstable angina.

• ECG up to 3 months after initial diagnosis of heart failure.

• ECG up 2 days of initial diagnosis of TIA.

• Chest radiograph up to 3 months after initial diagnosis of heart failure.

• Carotid imaging up to 2 weeks after initial diagnosis for patients hospitalized with carotid artery stroke.

• Carotid endarterectomy up to 2 months after carotid imaging for cerebrovascular accident patients with eventual carotid endarterectomy.

• Carotid endarterectomy up to 2 months after carotid imaging for TIA patients with eventual carotid endarterectomy.

• Cholecystectomy for patients with cholelithiasis plus cholecystitis, cholangitis, or gallstone pancreatitis.

• Arthroplasty or internal fixation of hip during hospital stay for hip fracture.

Among the study’s strengths, Dr. Snyder said that it examined the initial transition from acute cancer treatment to survivorship, an important time to ensure that survivors do not get lost in transition.

Discussant Lynne I. Wagner, Ph.D., of Northwestern University in Chicago said that this represented a novel contribution to the evidence base in survivorship care. "The comorbidity issues are extremely important. This is probably the tip of the iceberg in terms of what’s going on," she said.

The study was funded by the National Cancer Institute. Neither Dr. Snyder nor Dr. Wagner disclosed relevant relationships.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

CHICAGO – The bone loss associated with aromatase inhibitors was significantly slowed with increasing supplements of vitamin D in a prospective cohort study of 156 postmenopausal women.

"The bone loss was less, the higher your vitamin D level was maintained," said session chair Dr. Thomas J. Smith of Massey Cancer Center of Virginia Commonwealth University. "This is one of the first intervention studies," he said. "And the results are pretty striking."

Dr. Sonia Servitja of Hospital del Mar in Barcelona, and colleagues, assessed the association between 25-hydroxy-vitamin D (25(OH)D) concentrations and bone loss at baseline, after 3 months of supplementation, and after 1 year, in patients receiving aromatase inhibitor therapy for early-stage breast cancer.

The 156 women in the prospective cohort had hormone-positive breast cancer and had initiated aromatase inhibitors from January 2006 to June 2009.

All patients received daily oral calcium (1 g) and vitamin D3 (800 IU). Patients with a baseline level of 25(OH)D less than 30 ng/mL received additional oral vitamin D3. The women were a mean age of 62 years with a mean age of menopause onset of 50 years.

The magnitude of the bone-loss prevention correlated with incremental increases in 25(OH)D concentrations.

Each 10-ng/mL increase in 25(OH)D concentration at 3 months appeared to be associated with a 0.55% decrease in bone loss, which was almost a third of the average bone loss experienced by these patients, according to the study findings, presented as a poster at the annual meeting of the American Society of Clinical Oncology.

The findings suggest that vitamin D supplementation at doses higher than the standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Patients who achieved 25(OH)D concentrations greater than or equal to 40 ng/mL at 3 months experienced significantly reduced bone loss. In addition, 25(OH)D increases at 3 months were protective for relative bone loss (adjusted beta for each quintile 1.01%, P value less than .001).

Dr. Servitja disclosed no relevant relationships. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.

Major Finding: Medical oncologists and primary care physicians perceive different barriers to care when dealing with survivors of breast and colon cancer. Barriers include inadequate physician training, the practice of defensive medicine (against malpractice), and confusion about responsibility and delivery of care. More education and survivorship care planning are needed.

Data Source: Survey study of 2,202 physicians (from an AMA cohort of 5,275).

Disclosures: Cosponsored by the National Cancer Institute and the American Cancer Society. Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

“Increased coordination of care is needed to ensure continuity of care,” said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute.

“Yet barriers to achieving care remain in our fragmented health care system.”

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

“Bivariate results show that the physicians' specialty was significantly associated with all five barriers,” Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians.

More primary care physicians said fear of malpractice was sometimes (40% vs 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, vs 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

“PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems,” said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases), she said.

'Increased coordination of care is needed to ensure continuity of care.'

Source DR. VIRGO

Major Finding: Medical oncologists and primary care physicians perceive different barriers to care when dealing with survivors of breast and colon cancer. Barriers include inadequate physician training, the practice of defensive medicine (against malpractice), and confusion about responsibility and delivery of care. More education and survivorship care planning are needed.

Data Source: Survey study of 2,202 physicians (from an AMA cohort of 5,275).

Disclosures: Cosponsored by the National Cancer Institute and the American Cancer Society. Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

“Increased coordination of care is needed to ensure continuity of care,” said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute.

“Yet barriers to achieving care remain in our fragmented health care system.”

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

“Bivariate results show that the physicians' specialty was significantly associated with all five barriers,” Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians.

More primary care physicians said fear of malpractice was sometimes (40% vs 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, vs 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

“PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems,” said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases), she said.

'Increased coordination of care is needed to ensure continuity of care.'

Source DR. VIRGO

Major Finding: Medical oncologists and primary care physicians perceive different barriers to care when dealing with survivors of breast and colon cancer. Barriers include inadequate physician training, the practice of defensive medicine (against malpractice), and confusion about responsibility and delivery of care. More education and survivorship care planning are needed.

Data Source: Survey study of 2,202 physicians (from an AMA cohort of 5,275).

Disclosures: Cosponsored by the National Cancer Institute and the American Cancer Society. Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

“Increased coordination of care is needed to ensure continuity of care,” said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute.

“Yet barriers to achieving care remain in our fragmented health care system.”

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

“Bivariate results show that the physicians' specialty was significantly associated with all five barriers,” Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians.

More primary care physicians said fear of malpractice was sometimes (40% vs 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, vs 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

“PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems,” said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases), she said.

'Increased coordination of care is needed to ensure continuity of care.'

Source DR. VIRGO