Use of Guideline Recommended Follow-Up Care in Cancer Survivors

Abstract

Office visits and testing for local recurrence of cancer generally are performed for routine surveillance, regardless of recommendation by practice guidelines. Because procedures not recommended by practice guidelines were more often for diagnostic purposes, classification of patients as undergoing intensive surveillance may be misleading and may require record review to confirm.

The Utility of Administrative Data for Measuring Adherence to Cancer Surveillance Care Guidelines

“…Third, the present study included all potential surveillance procedures, regardless of whether they were performed for routine or diagnostic purposes. In a previous study using medical record reviews of a related sample of patients, 34 we found that both physical examinations and guideline recommended procedures were most often performed for routine surveillance but tests for metastatic recurrence were often ordered to evaluate signs or symptoms. Because in the current study we considered procedures performed for any indication (routine or diagnostic), categorization of care as being in excess of guidelines based on use of metastatic disease testing may be misleading.…”

Surveillance Practice Patterns After Curative Intent Therapy for Stage I Non-small Cell Lung Cancer in the Medicare Population

“…[27,37,46,54] We found several factors to be associated with guideline adherence, including age, access to primary care, and comorbidities. Elderly patients may be particularly at risk of not receiving guideline-based lung cancer care.…”

“…Although adherence to surveillance guidelines has been well characterized for breast and colorectal cancer and other areas of lung cancer care, [27,[37][38][39][40][41][42][43][44][45][46] few studies have examined surveillance practice patterns after curative therapy for NSCLC. Most of these studies have relied on small patient-populations [47] or physician surveys.…”

“…[26,27] Thus, our aims were twofold; first, we evaluated clinical practice patterns for imaging surveillance of stage I NSCLC after curative intent therapy in the Medicare population by tracking the use of CXR, CT, and PET scans during the first 2 years after treatment. Second, we compared these practice patterns to contemporaneous practice guidelines.…”

Use of Imaging for Staging of Early-Stage Breast Cancer in Two Integrated Health Care Systems: Adherence With a Choosing Wisely Recommendation

“…The abstractors, with supervision and consultation with the site principal investigators and research team, categorized imaging services as diagnostic (used in response to a clinical sign found on physical exam, prior finding, or patient reported symptom) or routine (used in absence of signs or symptoms indicative of potential metastatic disease), based on categories developed by Cooper et al to categorize surveillance services in cancer care. 23 These categories, although developed to categorize cancer surveillance services, are broadly applicable for capturing clinical indication of services. Categorization of diagnostic or routine was based on the clinician note(s) associated with the imaging service, and documented signs and symptoms were captured in a study database to aid in categorization.…”