Betsy C Risendal1, Rebecca L Sedjo2, Anna R Giuliano3, Susan Vadaparampil4, Paul B Jacobsen4, Kristin Kilbourn5, Anna Barón6, Tim Byers7. 1. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA. betsy.risendal@ucdenver.edu. 2. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA. 3. Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, USA. 4. Department of Health Outcomes and Behavior, H Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA. 5. Department of Psychology, University of Colorado Denver, Downtown Campus, North Classroom, 5002-M, Denver, CO, USA. 6. Department of Biostatistics and Informatics, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA. 7. Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA.
Abstract
PURPOSE: Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors. METHODS: Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients' beliefs were compared by provider type using multivariate logistic regression. RESULTS: No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5-5.8; and other blood tests: OR = 2.0, 95 % CI 1.1-3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity. CONCLUSIONS: Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type. IMPLICATIONS FOR CANCER SURVIVORS: Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.
PURPOSE: Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors. METHODS:Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients' beliefs were compared by provider type using multivariate logistic regression. RESULTS: No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5-5.8; and other blood tests: OR = 2.0, 95 % CI 1.1-3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity. CONCLUSIONS: Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type. IMPLICATIONS FOR CANCER SURVIVORS: Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.
Entities:
Keywords:
American Society of Clinical Oncology (ASCO)-recommended surveillance tests; Beliefs; Breast cancer; Prospective study; Provider type; Women
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