American Society of Clinical Oncology‐recommended surveillance and physician specialty among long‐term breast cancer survivors

Abstract

BACKGROUND: It is unclear whether it is appropriate to transfer the follow-up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long-term surveillance of survivors who underwent surgery at an American academic center. METHODS: Women in this institutional review board-approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow-up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care. RESULTS: The majority of patients (90%; n ¼ 242) were followed by specialists with 10% (n ¼ 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO-recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow-up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at Year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%; P ¼ .001-.02). CONCLUSIONS: Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice.

Influence of Primary Care on Breast Cancer Outcomes Among Medicare Beneficiaries

“…[67][68][69][70][71][72] Although it is possible such actions could infl uence breast cancer mortality, 49 it is not certain whether such care is typical in primary care encounters. 73,74 Visits to primary care physicians were also associated with lower overall mortality for women with diagnosed breast cancer. Potential mechanisms by which primary care visits could affect overall mortality include promoting preventive services 75,76 and managing comorbid illnesses, which occur in most cancer patients.…”

Follow-Up Care Experiences and Perceived Quality of Care Among Long-Term Survivors of Breast, Prostate, Colorectal, and Gynecologic Cancers

“…22 Shared care models have emerged as a way to meet survivors' complex care needs. 20,[23][24][25] A substantial number of our longterm survivors did see multiple physicians for follow-up care (40.8%); however, few reported receiving care by both an oncology specialist and a PCP (27.6%), which is typically proposed as the preferred model of shared care. Most survivors reported having a PCP (96.5%), but Ͻ half reported PCP participation in follow-up care (43.4%).…”

“…The inclusion of multiple providers in follow-up care suggests challenges for care coordination. 2,24,25 Importantly, 14% of survivors could not identify a main follow-up care provider, and these survivors were significantly less likely to report highquality care. We could not ascertain whether care received from multiple providers was complementary or duplicative, but this will be a crucial topic for future studies, as will health-related outcomes achieved by different care models.…”

Hazard of Recurrence among Women after Primary Breast Cancer Treatment—A 10-Year Follow-up Using Data from SEER-Medicare

“…Surveillance care after primary cancer treatment is a new area of research for the care of cancer survivors in recent years (3)(4)(5)(6)(7). Several organizations have provided guidelines for clinical surveillance or follow-up of women after breast cancer treatment (4,5,8), including the American Society of Clinical Oncology (ASCO), which recommends periodic outpatient clinic visits for the patient to be examined for a possible recurrence or a second primary breast tumor and also to receive information and psychosocial support.…”

“…Several organizations have provided guidelines for clinical surveillance or follow-up of women after breast cancer treatment (4,5,8), including the American Society of Clinical Oncology (ASCO), which recommends periodic outpatient clinic visits for the patient to be examined for a possible recurrence or a second primary breast tumor and also to receive information and psychosocial support. The recommended schedules involve clinic visits every 3 to 6 months for the first 3 years, visits every 6 to 12 months for years 4 and 5, and annual visits after 5 years (9).…”