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

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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.

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Acknowledgments

Funding for the SUNSHINE study was provided by the American Cancer Society (RSGT-06-087-01 CPPB). The authors would like to thank the subjects of this study for their participation.

Conflict of interest

None of the authors have a conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA

    Betsy C. Risendal & Rebecca L. Sedjo

  2. Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, USA

    Anna R. Giuliano

  3. Department of Health Outcomes and Behavior, H Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA

    Susan Vadaparampil & Paul B. Jacobsen

  4. Department of Psychology, University of Colorado Denver, Downtown Campus, North Classroom, 5002-M, Denver, CO, USA

    Kristin Kilbourn

  5. Department of Biostatistics and Informatics, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA

    Anna Barón

  6. Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA

    Tim Byers

Authors
  1. Betsy C. Risendal
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  2. Rebecca L. Sedjo
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  3. Anna R. Giuliano
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  4. Susan Vadaparampil
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  5. Paul B. Jacobsen
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  6. Kristin Kilbourn
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  7. Anna Barón
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  8. Tim Byers
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Corresponding author

Correspondence to Betsy C. Risendal.

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Risendal, B.C., Sedjo, R.L., Giuliano, A.R. et al. Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers. J Cancer Surviv 10, 96–102 (2016). https://doi.org/10.1007/s11764-015-0454-y

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  • DOI: https://doi.org/10.1007/s11764-015-0454-y

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