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

Abstract

This study estimates the costs of clinical follow-up for women with early stage breast cancer and evaluates the effects of patient and provider characteristics on follow-up intensity. Claims data were cumulated from 1/1/89 through 4/30/93 for a comprehensive set of follow-up tests (office visits, radiologic, and laboratory) ordered for 222 women diagnosed at a university hospital between 1/1/89 and 12/31/91. Aggregated measures of the volume and costs of follow-up over 6 month intervals were expressed in terms of Medicare's 1993 relative value units (RVUs) and their 1993 cost equivalents. Excluding the first 6 months, women received on average, 11.7 RVUs of follow-up in the first year (equivalent to a cost of $362), and 9.5 RVUs in the second year ($297). In the first year, chest x-rays, clinical chemistry tests, automated hemograms, and bone scans, accounted for 36% of the cost of follow-up, while computerized tomographic scans and magnetic resonance imaging studies accounted for 30%. Multiple regression analysis of the first year data showed that women who received radiation and/or were followed by oncology, were more likely to receive intensive follow-up. Age, race, socioeconomic status, insurance, stage, and treatment did not impact follow-up. Costs of follow-up for breast cancer are substantial, though much lower than suggested by others. Additionally, wide variations in practice are largely unexplained by patient and/or provider characteristics. In light of recent evidence questioning the benefit of intensive surveillance, this study supports the need for an accepted set of follow-up guidelines for breast cancer.

Professionals’ opinion on follow-up in breast cancer patients; perceived purpose and influence of patients’ risk factors

“…The majority indicate no extra tests are needed, in line with previous reports that show no decrease in morbidity or mortality from extra testing 6,12 . Like other authors 36,37 , we found that medical oncologists tend to do more laboratory tests, although this is not effective for detecting recurrent disease. Increased tests may be related to checking blood results during ongoing hormone therapy; we did not specify this question on patient or tumour characteristics.…”

Impact of breast carcinoma on African-American women

“…Of note, preliminary data suggest that ethnicity is not likely to be associated with significant variations in follow‐up of women with a breast carcinoma. Simon et al46 evaluated this issue in a study of claims data of patients with breast carcinoma during the 2.5‐year period after primary cancer treatment and found no difference in extent of follow‐up based on age, ethnicity, or socioeconomic factors. This study evaluated follow‐up by compiling claims submitted for office visits, laboratory tests, and radiographic studies according to hospital and billing office records.…”

Identifying tests related to breast cancer care in claims data

“…[7,9] Some prior claims-based studies of advanced imaging in breast cancer care have simply ignored the issue of distinguishing between imaging performed for cancer care versus background imaging. [10] Others have defined breast cancer surveillance testing using only those tests originating from a physician visit associated with a diagnosis code for invasive breast cancer or breast cancer in situ. [5] The utilization of testing in general-and high cost, advanced diagnostic imaging such as CT, MRI, and PET in particular-continues to increase in various phases of breast cancer management.…”