br Methods Cross sectional analysis of survey
Methods: Cross-sectional analysis of survey data from 637 Medicare beneficiaries (≥65 years) with breast (n = 304), lung (n = 158), or prostate cancer (n = 175) in twelve hospitals in the Southeastern United States. Partic-ipants responded eighteen satisfaction questions across five domains. HRQoL was measured with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12.v2 instrument.
Results: SF-12 scores were positively associated with satisfaction domain scores. The magnitude of these associ-ations was small with covariate-adjusted effect sizes r ranging from 0.05 to 0.12. Satisfaction scores were highest within the Quality of Care domain and lowest within the Patient Engagement domain. Conclusions: Patient satisfaction domains had only modest association with HRQoL, indicating that Doxorubicin these con-structs should not be assumed to correlate. Satisfaction domains, including how patients access care, coordinate care, and engage within the healthcare system, were identified as potential areas for improvement. Patient sat-isfaction assessment across age groups may inform oncology care providers on ways in which their patients per-ceive the quality of care received, which ultimately affect healthcare organizations' accreditation, ranking, and reimbursement.
Patient satisfaction is an important factor in the overall assessment of quality of care and is often used by institutions to identify areas of patient need, develop programs to improve patient outcomes, and com-pare institutional performance . Among oncology patients, care is complex and often requires multidisciplinary levels of support from a wide range of health care and service providers. Patients often face mul-tiple physical, psychological, and educational challenges throughout
E-mail address: firstname.lastname@example.org (A. Azuero).
their disease course, which may contribute to patient perception of their care. Patient satisfaction with care has been grouped into domains that include patient perceptions of access to care, coordination of care, communication with providers, overall quality of treatment, and patient engagement .
Patient satisfaction with care has been extensively studied in oncol-ogy patients across different types of cancers and settings [3–9]. How-ever, limited data exist on patient satisfaction solely in older patients with cancer [10,11], with most studies reporting results from a hetero-geneous group of patients across a wide range of ages . Older adults are the most rapidly growing segment of persons living with cancer; 62% of all cancer cases in the United States in 2016 were among adults 65 years or older , and appendix is expected to increase to 70% by 2030
. The knowledge gap regarding satisfaction in older adults living with cancer is problematic because age has been shown to be associated with patient satisfaction in a number of domains [14–18]. Specifically, the needs of older patients in regards to communication and engage-ment with their oncology team may differ from the needs of you-nger patients due to cognitive, sensory, or physical changes related to aging, thus requiring different communication approaches [19–21]. In addition, despite Medicare coverage for patients over 65 years of age, difficulties accessing care may be an issue that impacts a patient's sense of satisfaction when care is actually received.
Patient satisfaction among older adults is also important to health-care organizations when seeking accreditation or reimbursement. For instance, the Centers for Medicare and Medicaid Services (CMS) Con-sumer Assessment of Healthcare Providers and Systems (CAHPS) sur-veys are utilized when awarding performance-based incentives . As such, understanding the factors that influence patient satisfaction is of value when developing interventions to improve overall care and provider reimbursement. Despite the emphasis on patient satisfaction in quality metrics and reimbursement, the association between patient satisfaction with care and health-related quality of life (HRQoL) has been less studied, particularly in older patients with cancer. Better HRQoL has been associated with lower symptom burden and better overall health status [5–7,10], which may correlate with patients' per-ception of care. Due to increased comorbidities in older patients  and therefore lower overall health status, which could in turn have a detrimental effect on satisfaction, a better understanding of the associa-tion between HRQoL and satisfaction with care among this age group is needed.
The purpose of this study was to investigate the relationship betw-een patient satisfaction with care and HRQoL among Medicare recipi-ents with common cancer types (breast, lung, or prostate cancer). We hypothesized a positive relationship of relevant magnitude between HRQoL and patient satisfaction with care.