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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2013

01-12-2013 | Breast Oncology

Patient Demographic and Tumor Characteristics Influencing Oncologist Follow-Up Frequency in Older Breast Cancer Survivors

Authors: Heather B. Neuman, MD, MS, Jennifer M. Weiss, MD, MS, Deborah Schrag, MD, MPH, Katie Ronk, BS, Jeffrey Havlena, MS, Noelle K. LoConte, MD, Maureen A. Smith, MD, MPH, PhD, Caprice C. Greenberg, MD, MPH

Published in: Annals of Surgical Oncology | Issue 13/2013

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Abstract

Background

Although recommendations for breast cancer follow-up frequency exist, current follow-up guidelines are standardized, without consideration of individual patient characteristics. Some studies suggest oncologists are using these characteristics to tailor follow-up recommendations, but it is unclear how this is translating into practice. The objective of this study was to examine current patterns of oncologist breast cancer follow-up and determine the association between patient and tumor characteristics and follow-up frequency.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify stage I–III breast cancer patients diagnosed 2000–2007 (n = 39,241). Oncologist follow-up visits were defined using Medicare specialty provider codes and the linked AMA Masterfile. Multinomial logistic regression determined the association between patient and tumor characteristics and oncologist follow-up visit frequency.

Results

Younger age (p < 0.001), positive nodes (p < 0.001), estrogen receptor/progesterone receptor positivity (p < 0.001), and increasing treatment intensity (p < 0.001) were most strongly associated with more frequent follow-up. However, after accounting for these characteristics, significant variation in follow-up frequency was observed. In addition to patient factors, the number and types of oncologists involved in follow-up were associated with follow-up frequency (p < 0.001). Types of oncologists providing follow-up varied, with medical oncologists the sole providers of follow-up for 19–51 % of breast cancer survivors. Overall, 58 % of patients received surgical oncology, and 51 % undergoing radiation received radiation oncology follow-up, usually in combination with medical oncology.

Conclusions

Significant variation in breast cancer follow-up frequency exists. Developing follow-up guidelines tailored for patient, tumor, and treatment characteristics while also providing guidance on who should provide follow-up has the potential to increase clinical efficiency.
Appendix
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Metadata
Title
Patient Demographic and Tumor Characteristics Influencing Oncologist Follow-Up Frequency in Older Breast Cancer Survivors
Authors
Heather B. Neuman, MD, MS
Jennifer M. Weiss, MD, MS
Deborah Schrag, MD, MPH
Katie Ronk, BS
Jeffrey Havlena, MS
Noelle K. LoConte, MD
Maureen A. Smith, MD, MPH, PhD
Caprice C. Greenberg, MD, MPH
Publication date
01-12-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3170-8

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