Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

Abstract Background Primary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces. Methods The cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007–2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4). Results PCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival. Conclusions Contrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care

“Così è (se vi pare)”: Remarks on subjective well-being from a resource-based perspective

The present international interest on subjective well-being in research and policy-making is put under a critical eye from the perspective of the Scandinavian resource-based approach on well-being. In its stereotypical formulation, the Scandinavian approach is first and foremost interested in access to sufficient resources for all, and also in fair distribution of resources in the population. The approach leaves little space for subjective well-being, or leaves it as a private issue that is not a policy concern. From the Scandinavian perspective, it seems that many research ideas and policy proposals inspired by subjective well-being can be returned to resource-based approach. The paper discusses critically some recent proposals of strengthening the role of subjective well-being in research and policy. It also points out that the Scandinavian approach is not a monolith, but a number of side currents have always existed there, including ideas related to subjective well-being. Finally, the paper describes a rising interest in subjective well-being in the Nordic countries, too, although resource-based approach still dominates in welfare policies