Top

Published in:

01-02-2016

Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers

Authors: Betsy C. Risendal, Rebecca L. Sedjo, Anna R. Giuliano, Susan Vadaparampil, Paul B. Jacobsen, Kristin Kilbourn, Anna Barón, Tim Byers

Published in: Journal of Cancer Survivorship | Issue 1/2016

Abstract

Purpose

Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors.

Methods

Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients’ beliefs were compared by provider type using multivariate logistic regression.

Results

No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5–5.8; and other blood tests: OR = 2.0, 95 % CI 1.1–3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity.

Conclusions

Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type.

Implications for Cancer Survivors

Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.

Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(5):220–41.PubMedCrossRef

Warren JL, Marriotto AB, Meekins A, Topor M, Brown ML. Total annual oncology visits by phase of care, 2005 to 2020. J Clin Oncol. 2008;26:3242–7.PubMedCrossRef

Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961–5.PubMedCrossRef

Grunfeld E, Hodgson DC, Del Giudice ME, Moineddin R. Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract. 2010;6(4):174–81.PubMedPubMedCentralCrossRef

Jochelson M, Hayes DF, Ganz PA. Surveillance and monitoring in breast cancer survivors: maximizing benefit and minimizing harm. Am Soc Clin Oncol Educ Book. 2013; 13–18.

Keating NL, Landrum MB, Guadagnoli E, Weiner EP, Ayanian JZ. Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol. 2007;25(9):1074–81.PubMedCrossRef

Salloum RG, Hornbrook MC, Fishman PA, Ritzwoller DP, O’Keeffe Rossetti MC, Elston Lafata J. Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent. Cancer. 2012;118(22):5644–51.PubMedPubMedCentralCrossRef

Slattery ML, Sweeney C, Edwards S, Herrick J, Baumgartner K, Wolff R, Murtaugh M, Baumgartner R, Giuliano A, Byers T. Body size, weight change, fat distribution, and breast cancer risk in Hispanic and non-Hispanic White women. Breast Caner Res Treat 102(1):85–101.

Sedjo RL, Hines LM, Byers T, Giuliano AR, Marcus A, Vadaparmpil S, et al. Nutr Cancer. 2013;65(1):34–42.PubMedCrossRef

10.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091–7.PubMedCrossRef

11.

Grunfeld E, Levine MN, Julian JA, Coyle D, Szaetchman B, Mirksky D, et al. Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol. 2006;24(6):848–55.PubMedCrossRef

12.

Baena-Canada JM, Ramirez-Daffos P, Cortes-Carmona C, Rosado-Varela P, Nieto-Vera J, Benitez-Rodriguez E. Follow-up of long-term survivors of breast cancer in primary care vs. specialist attention. Fam Pract. 2013 June 26; epub ahead of print.

13.

Klabunde CN, Han PK, EarleCC ST, Ayanian JZ, Lee R, Ambs A, et al. Physician roles in the cancer-related follow-up care of cancer survivors. Fam Med. 2013;45(7):463–74.PubMedPubMedCentral

14.

Han PK, Klabunde CN, Noone AM, Earle CC, Ayanian JZ, Ganz PA, et al. Physicians’ beliefs about breast cancer surveillance testing are consistent with test overuse. Med Care. 2013;51(4):315–23.PubMedPubMedCentralCrossRef

15.

Hollowell K, Olmsted CL, Richardson AS, Pittman HK, Bellin L, Tafra L, et al. American Society of Clinical Oncology-recommended surveillance and physician specialty among long-term breast cancer survivors. Cancer. 2010;116(9):2090–8.PubMed

16.

Doubeni CA, Field TS, Ulcickas YM, Rolnick SJ, Quessenberry CP, Fouayzi H, et al. Patterns and predictors of mammography utilization among breast cancer survivors. Cancer. 2006;106(11):2482–8.PubMedCrossRef

17.

Virgo KS, Lerro CC, Klabunde CN, Earle C, Ganz PA. Barriers to breast and colorectal cancer survivorship care: perceptions of primary care physicians and medical oncologists in the United States. J Clin Oncol. 2013;20(3):2322–36.CrossRef

18.

Advani PS, Ying J, Theriault R, Melhem-Bertrand A, Moulder S, Bedrosian I, et al. Ethnic disparities in adherence to breast cancer survivorship surveillance care. Cancer. 2013. doi:10.1002/cncr.28490.PubMedPubMedCentral

19.

Wirtz HS, Boudreau DM, Gralow JR, Barlow WE, Gray S, Bowles EJ, et al. Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat. 2014;143(3):541–50. doi:10.1007/s10549-013-2816-3.PubMedPubMedCentralCrossRef

20.

Buist DS, Bosco JL, Silliman RA, Gold HT, Field T, Yood MU, et al. Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer. Breast Cancer Res Treat. 2013;142(1):153–63. doi:10.1007/s10549-013-2720.PubMedCrossRef

21.

Erikson C, Schulman S, Kosty M, Hanley A. Future supply and demand for oncologists. J Oncol Pract. 2009;5(2):62–53.PubMedPubMedCentralCrossRef

22.

Hewitt, M, Greenfield S, Stovall, E. From cancer patient to cancer survivor: lost in transition. The National Academies Press, 2005; ISBN: 978-0-309-09595-2.

23.

Rechis R, Arvey SR, Beckjord EB. Perspective of a lifelong cancer survivor—improving survivorship care. Nat Rev Clin Oncol. 2013;10(2):117–20.PubMedCrossRef

Title: Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers
Authors: Betsy C. Risendal
Rebecca L. Sedjo
Anna R. Giuliano
Susan Vadaparampil
Paul B. Jacobsen
Kristin Kilbourn
Anna Barón
Tim Byers
Publication date: 01-02-2016
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 1/2016
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-015-0454-y

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Please log in to get access to this content

Other articles of this Issue 1/2016

What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses

Incidence of second primary cancers in North Portugal—a population-based study

Hanging by a thread: exploring the features of nonresponse in an online young adult cancer survivorship support community

Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care

Pregnancy-associated cardiomyopathy in survivors of childhood cancer

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories

Keynote webinar | Spotlight on antibody–drug conjugates in cancer