Quality of Preventive Care Before and After Prostate Cancer Diagnosis

Objective: To examine whether general preventive services were diminished in a cohort of men after their diagnosis of prostate cancer. Method: A total of 16,604 men enrolled in Kaiser Permanente Southern California who were newly diagnosed with prostate cancer from January 1, 2002, through December 31, 2009, were passively followed through EMRs to determine the use of preventive services, including screening for colorectal cancer (colonoscopy and/or fecal occult blood tests [FOBT]), tests for diabetes (glucose and hemoglobin A1c), heart disease (serum cholesterol, high-density lipoprotein [HDL], and triglycerides), and vaccinations (influenza and pneumococcal). Preventive service use was compared in the 2 years prior to and following prostate cancer diagnosis, using matched odds ratios (MORs) and 95% confidence intervals (CIs) in 2013. Results: Men were more likely to receive a flu vaccine (MOR 2.70, 95% CI 2.52-2.90), lipid tests (MOR 1.51, 95% CI 1.42-1.61), diabetes tests (MOR 2.13, 95% CI 2.00-2.26), and screening for colorectal cancer (MOR 1.80, 95% CI 1.71-1.89) in the 2 years after prostate cancer diagnosis, compared to before diagnosis. Men with advanced disease at diagnosis were more likely to receive all types of preventive services after diagnosis, compared to men with localized disease. Conclusion: Once diagnosed with prostate cancer in this setting, no less attention was paid to general preventive care, although there remains room for improvement in pneumococcal vaccination and colon cancer screening rates. The delivery of high-quality continuing care after diagnosis is critical for aging cancer patients.