An evaluation of clinical follow-up in women with early stage breast cancer among physician members of the American Society of Clinical Oncology

Abstract

Routine clinical follow-up for distant metastatic disease among women with early stage breast cancer is of uncertain clinical benefit. In order to evaluate current practice patterns, we administered a mailed survey to a stratified random sample of physician members of the American Society of Clinical Oncology (ASCO) (N = 435). The survey assessed the frequency and motivation for ordering follow-up medical tests in asymptomatic postmenopausal women with stage I or II breast cancer. The response rate was 55%, distributed as 39% radiation oncologists, 32% medical oncologists, and 29% surgeons. In the first year after treatment, physicians performed, on average, one physical examination every 3 months, one blood panel (CBC, alkaline phosphatase and liver function tests) every 4 months, and one chest radiograph every 9 months. In addition, 38% of the respondents ordered CEA and 21% ordered CA 15-3 levels, 28% ordered bone scans, and less than 4% ordered CT scans, bone surveys, or bone marrow biopsies in the first year after treatment. A logistic regression analysis controlling for physician age, gender, sub-specialty, practice type, years of experience, number of breast cancer patients treated annually, geographic region, and community size, showed that surgeons were less likely to order blood tests (p < 0.001) and tumor markers (p < 0.0029) than medical oncologists in years 3 and 5 of follow-up. Compared to physicians practicing in the northeast, those from the midwest were less likely to order chest radiographs in year 3 of follow-up (p = 0.0028). Other provider characteristics had no significant effect on test ordering behavior. The results of this survey suggest that relatively uniform practice patterns in regard to the follow-up of postmenopausal women with early stage breast cancer exist among ASCO physicians.

Clinical surveillance for early stage breast cancer: An analysis of claims data

“…We excluded follow-up tests that were ordered during the first 6 months post-diagnosis, which coincides with the administration of chemo and/or radiation therapy [44]. Our 1 year estimate is very close to the value of 11.7 RVUs derived from a survey that we conducted of follow-up practices among physician members of the American Society of Clinical Oncology (ASCO) [51,52]. Considering an estimated 183,000 new breast cancer cases in the United States in 1993, approximately 70% or 128,100 of which were stage I or II, the 1993 cost of 1 year of breast cancer surveillance, based on our figures is estimated at $46,372,200 (128,100 x $362).…”

“…While univariate analyses showed that women that underwent partial mastectomy or radiation therapy had more intensive follow-up, multivariate analysis suggested that women who had radiation (which included the majority of women who had conservative surgery) were the one's who had higher costs for follow-up care. As shown in the AS-CO survey [51,52], women who were followed by a medical oncologist were also more likely to have more follow-up tests ordered. Contrary to other reports which showed poor health care delivery rates in patients that are black, poorly insured, and/or from a low SES background [53,54], the level of follow-up care for women in our institution was not associated with race or SES.…”

Routine Liver Imaging is Unnecessary in the Work-Up of T1-2 NO-1 Breast Cancer

“…10 A survey done by the American Society of Clinical Oncology (ASCO) revealed that practice patterns among ASCO member physicians with regards to follow-up of postmenopausal women with early breast cancer (stage I and II) was in accordance with the society guidelines. 11 The extent of preoperative work-up is not standardized by most professional organizations except for a few. For example, the NCCN does not recommend LI in early breast cancer assessment.…”

An analysis of the cost of clinical surveillance after primary therapy for women with early stage invasive breast cancer

“…ASCO is the largest association of cancer specialists engaged in clinical research and patient care in the United States, and consisted of 8144 active members at the time of the survey [38]. Specific details of the sample selection process and power calculations were described previously [11]. A three-stage stratified simple random sampling design was employed for subject selection, based on geographic region, city size, and medical sub-specialty.…”

“…In the current study we used the results of a previously published survey of physician members of the American Society of Clinical Oncologists (ASCO) to estimate the cost of routine medical surveillance for women with early stage breast cancer [11]. We also looked at a number of demographic variables as potential predictors of physician practice patterns.…”