BACKGROUND: Although recommendations for breast cancer follow-up frequency exist, current follow-up guidelines are standardized, without consideration of individual patient characteristics. Some studies suggest oncologists are using these characteristics to tailor follow-up recommendations, but it is unclear how this is translating into practice. The objective of this study was to examine current patterns of oncologist breast cancer follow-up and determine the association between patient and tumor characteristics and follow-up frequency. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify stage I-III breast cancer patients diagnosed 2000-2007 (n = 39,241). Oncologist follow-up visits were defined using Medicare specialty provider codes and the linked AMA Masterfile. Multinomial logistic regression determined the association between patient and tumor characteristics and oncologist follow-up visit frequency. RESULTS: Younger age (p < 0.001), positive nodes (p < 0.001), estrogen receptor/progesterone receptor positivity (p < 0.001), and increasing treatment intensity (p < 0.001) were most strongly associated with more frequent follow-up. However, after accounting for these characteristics, significant variation in follow-up frequency was observed. In addition to patient factors, the number and types of oncologists involved in follow-up were associated with follow-up frequency (p < 0.001). Types of oncologists providing follow-up varied, with medical oncologists the sole providers of follow-up for 19-51 % of breast cancer survivors. Overall, 58 % of patients received surgical oncology, and 51 % undergoing radiation received radiation oncology follow-up, usually in combination with medical oncology. CONCLUSIONS: Significant variation in breast cancer follow-up frequency exists. Developing follow-up guidelines tailored for patient, tumor, and treatment characteristics while also providing guidance on who should provide follow-up has the potential to increase clinical efficiency.
BACKGROUND: Although recommendations for breast cancer follow-up frequency exist, current follow-up guidelines are standardized, without consideration of individual patient characteristics. Some studies suggest oncologists are using these characteristics to tailor follow-up recommendations, but it is unclear how this is translating into practice. The objective of this study was to examine current patterns of oncologist breast cancer follow-up and determine the association between patient and tumor characteristics and follow-up frequency. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify stage I-III breast cancerpatients diagnosed 2000-2007 (n = 39,241). Oncologist follow-up visits were defined using Medicare specialty provider codes and the linked AMA Masterfile. Multinomial logistic regression determined the association between patient and tumor characteristics and oncologist follow-up visit frequency. RESULTS: Younger age (p < 0.001), positive nodes (p < 0.001), estrogen receptor/progesterone receptor positivity (p < 0.001), and increasing treatment intensity (p < 0.001) were most strongly associated with more frequent follow-up. However, after accounting for these characteristics, significant variation in follow-up frequency was observed. In addition to patient factors, the number and types of oncologists involved in follow-up were associated with follow-up frequency (p < 0.001). Types of oncologists providing follow-up varied, with medical oncologists the sole providers of follow-up for 19-51 % of breast cancer survivors. Overall, 58 % of patients received surgical oncology, and 51 % undergoing radiation received radiation oncology follow-up, usually in combination with medical oncology. CONCLUSIONS: Significant variation in breast cancer follow-up frequency exists. Developing follow-up guidelines tailored for patient, tumor, and treatment characteristics while also providing guidance on who should provide follow-up has the potential to increase clinical efficiency.
Authors: Laura-Mae Baldwin; Walter Adamache; Carrie N Klabunde; Kevin Kenward; Celia Dahlman; Joan L Warren Journal: Med Care Date: 2002-08 Impact factor: 2.983
Authors: Bruce G Haffty; Qifeng Yang; Michael Reiss; Thomas Kearney; Susan A Higgins; Joanne Weidhaas; Lyndsay Harris; Willam Hait; Deborah Toppmeyer Journal: J Clin Oncol Date: 2006-11-20 Impact factor: 44.544
Authors: James L Khatcheressian; Antonio C Wolff; Thomas J Smith; Eva Grunfeld; Hyman B Muss; Victor G Vogel; Francine Halberg; Mark R Somerfield; Nancy E Davidson Journal: J Clin Oncol Date: 2006-10-10 Impact factor: 44.544
Authors: Benjamin D Smith; Cary P Gross; Grace L Smith; Deron H Galusha; Justin E Bekelman; Bruce G Haffty Journal: J Natl Cancer Inst Date: 2006-05-17 Impact factor: 13.506
Authors: Nancy L Keating; Mary Beth Landrum; Edward Guadagnoli; Eric P Winer; John Z Ayanian Journal: J Clin Oncol Date: 2006-01-01 Impact factor: 44.544
Authors: Elizabeth B Lamont; James E Herndon; Jane C Weeks; I Craig Henderson; Craig C Earle; Richard L Schilsky; Nicholas A Christakis Journal: J Natl Cancer Inst Date: 2006-09-20 Impact factor: 13.506
Authors: Farah F Quyyumi; Jason D Wright; Melissa K Accordino; Donna Buono; Cynthia W Law; Grace C Hillyer; Alfred I Neugut; Dawn L Hershman Journal: J Oncol Pract Date: 2018-11-08 Impact factor: 3.840
Authors: Heather B Neuman; Nicole M Steffens; Nora Jacobson; Amye Tevaarwerk; Bethany Anderson; Lee G Wilke; Caprice C Greenberg Journal: Ann Surg Oncol Date: 2015-10-16 Impact factor: 5.344
Authors: Heather B Neuman; Jessica R Schumacher; Amanda B Francescatti; Taiwo Adesoye; Stephen B Edge; Elizabeth S Burnside; David J Vanness; Menggang Yu; Yajuan Si; Dan McKellar; David P Winchester; Caprice C Greenberg Journal: Ann Surg Oncol Date: 2016-08-04 Impact factor: 5.344
Authors: Heather B Neuman; Jessica R Schumacher; David F Schneider; Emily R Winslow; Rebecca A Busch; Jennifer L Tucholka; Maureen A Smith; Caprice C Greenberg Journal: Ann Surg Oncol Date: 2016-10-05 Impact factor: 5.344
Authors: Heather B Neuman; Paul J Rathouz; Emily Winslow; Jennifer M Weiss; Noelle K LoConte; Chee Paul Lin; Mike Wurm; Maureen A Smith; Deborah Schrag; Caprice C Greenberg Journal: J Eval Clin Pract Date: 2016-03-17 Impact factor: 2.431
Authors: J L Tucholka; N Jacobson; N M Steffens; J R Schumacher; A J Tevaarwerk; B Anderson; L G Wilke; C C Greenberg; Heather B Neuman Journal: Support Care Cancer Date: 2018-01-13 Impact factor: 3.603