A study from the University of California, San Francisco showed that women with lupus are sometimes neglected in terms of cancer screening and vaccinations. The authors started with the observation from previous studies that individuals with chronic diseases may receive fewer preventive services than the general population. This may happen because both patients and their doctors focus on the chronic disease, and because long-term illness is a financial handicap that limits insurance coverage and ability to pay.
For lupus, the overall prognosis has improved dramatically in the last few decades. The 5-year survival rate is above 95 percent in developed countries. Circulatory system disease is the leading cause of mortality in systemic lupus erythematosus (SLE) patients, followed by cancer and infections. Respiratory infections are the most common types of serious infections in these patients. Thus, the authors chose vaccinations for influenza and pneumonia, plus standard cancer screening tests, for their study.
The lupus subjects were English-speaking women with health insurance (private, Medicare, or Medicaid) from the Lupus Outcomes Study. The control subjects were women with similar demographics from the California Health Interview Survey.
The authors reported that cancer screening and immunizations for the two groups were similar. However, young women and those with lower education levels had significantly less preventive care. The overall results for the lupus patients are:
1.Cervical cancer screening for women over 65 with a uterus: 70 percent.
2.Mammogram for women over 40 years: 70 percent.
3.Colon cancer screening for women over 50 years: 62 percent.
4.Influenza vaccine for women over 50 years or immunosuppressed: 59 percent.
5.Pneumococcal vaccine for women over 65 or immunosuppressed: 60 percent.
The authors observed that 40 percent of patients without vaccinations is “notable”, since approximately one third of SLE deaths are attributed to infections.
Women without health insurance are likely to have worse preventive care than the ones in this study, the authors noted. They also pointed out that Health Maintenance Organizations emphasize preventive care, but did not provide better preventive care to lupus patients than other types of health insurance did.
Both groups (lupus patients and the general population) need better preventive care, the authors concluded. Patients with chronic illness may see their doctors more often, but still need to take the initiative to get cancer screenings and vaccinations.
Reference:
Yazdany J et al, “Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study”, Arthritis Research & Therapy 2010: 12:R84.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.