Abstract
Background
The current guidelines do not delineate the types of providers that should participate in early breast cancer follow-up care (within 3 years after completion of treatment). This study aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors and to identify factors associated with receipt of follow-up care from different types of providers.
Methods
Stages 1–3 breast cancer survivors treated from 2000 to 2007 were identified in the Surveillance, Epidemiology and End results Medicare database (n = 44,306). Oncologist (including medical, radiation, and surgical) follow-up and primary care visits were defined using Medicare specialty provider codes and linked American Medical Association (AMA) Masterfile. The types of providers involved in follow-up care were summarized. Stepped regression models identified factors associated with receipt of medical oncology follow-up care and factors associated with receipt of medical oncology care alone versus combination oncology follow-up care.
Results
Oncology follow-up care was provided for 80 % of the patients: 80 % with a medical oncologist, 46 % with a surgeon, and 39 % with a radiation oncologist after radiation treatment. The patients with larger tumor size, positive axillary nodes, estrogen receptor (ER)-positive status, and chemotherapy treatment were more likely to have medical oncology follow-up care than older patients with higher Charlson comorbidity scores who were not receiving axillary care. The only factor associated with increased likelihood of follow-up care with a combination of oncology providers was regular primary care visits (>2 visits/year).
Conclusions
Substantial variation exists in the types of providers that participate in breast cancer follow-up care. Improved guidance for the types of providers involved and delineation of providers’ responsibilities during follow-up care could lead to improved efficiency and quality of care.
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References
Khatcheressian JL, Hurley P, Bantug E, et al. Breast cancer follow-up and management after primary treatment: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2013;31:961–5.
National Comprehensive Cancer Network. National comprehensive cancer network clinical practice guidelines in oncology: breast Cancer. 2016: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 20 March.
Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975–2012. National cancer institute, Bethesda, MD. Accessed at http://seer.cancer.gov/csr/1975_2012/. based on November 2014 SEER data submission, posted to the SEER website April 2015.
Margenthaler JA, Allam E, Chen L, et al. Surveillance of patients with breast cancer after curative-intent primary treatment: current practice patterns. J Oncol Pract. 2012;8:79–83.
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;6:174–81.
Neuman HB, Weiss JM, Schrag D, et al. Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors. Ann Surg Oncol. 2013;20:4128–36.
Neuman HB, Rathouz PJ, Winslow ER, et al. Use of a novel statistical technique to examine the delivery of breast cancer follow-up care by different types of oncology providers. J Eval Clin Pract. 2016;22(5):737–44.
Institute of Medicine (IOM). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Institute. 2011;103:117–28.
The state of cancer care in America, 2014: a report by the American Society of Clinical Oncology. J Oncol Pract. 2014;10:119–42.
American Cancer Society. Cancer facts & figures. Atlanta, GA; 2016.
Keating NL, Landrum MB, Guadagnoli E, Winer EP, Ayanian JZ. Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol. 2006;24:85–94.
Lamont EB, Herndon JE II, Weeks JC, et al. Measuring disease-free survival and cancer relapse using Medicare claims from CALGB breast cancer trial participants (companion to 9344). J Natl Cancer Institute. 2006;98:1335–8.
Smith BD, Gross CP, Smith GL, Galusha DH, Bekelman JE, Haffty BG. Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Institute. 2006;98:681–90.
Stokes ME, Thompson D, Montoya EL, Weinstein MC, Winer EP, Earle CC. Ten-year survival and cost following breast cancer recurrence: estimates from SEER-Medicare data. Value Health. 2008;11:213–20.
Pollack LA, Adamache W, Eheman CR, Ryerson AB, Richardson LC. Enhancement of identifying cancer specialists through the linkage of Medicare claims to additional sources of physician specialty. Health Serv Res. 2009;44(2 Pt 1):562–76.
Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, Warren JL. Linking physician characteristics and Medicare claims data: issues in data availability, quality, and measurement. Med Care. 2002;40(8suppl):IV82–95.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
AJCC cancer staging manual. 6th ed. Springer, New York, 2002.
Cheung WY, Aziz N, Noone AM, et al. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Survivorship Res Pract. 2013;7:343–54.
Potosky AL, Han PK, Rowland J, et al. Differences between primary care physicians’ and oncologists’ knowledge, attitudes, and practices regarding the care of cancer survivors. J Gen Intern Med. 2011;26:1403–10.
Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC. Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med. 2009;24(Suppl 2):S459–66.
Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol. 2009;27:2489–95.
Hewitt ME, Bamundo A, Day R, Harvey C. Perspectives on posttreatment cancer care: qualitative research with survivors, nurses, and physicians. J Clin Oncol. 2007;25:2270–3.
Friese CR, Martinez KA, Abrahamse P, et al. Providers of follow-up care in a population-based sample of breast cancer survivors. Breast Cancer Res Treat. 2014;144:179–84.
Neuman HB, Steffens NM, Jacobson N, et al. Oncologists’ perspectives of their roles and responsibilities during multidisciplinary breast cancer follow-up. Ann Surg Oncol. 2016;23:708–14.
Freeborn DK, Pope CR, Mullooly JP, McFarland BH. Consistently high users of medical care among the elderly. Med Care. 1990;28:527–40.
Naessens JM, Baird MA, Van Houten HK, Vanness DJ, Campbell CR. Predicting persistently high primary care use. Ann Fam Med. 2005;3:324–30.
Giordano SH, Hortobagyi GN, Kau SW, Theriault RL, Bondy ML. Breast cancer treatment guidelines in older women. J Clin Oncol. 2005;23:783–91.
Owusu C, Lash TL, Silliman RA. Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women. Breast Cancer Res Treat. 2007;102:227–36.
Acknowledgment
Interpretation and reporting of these data are the sole responsibility of the authors. The efforts of the Applied Research Program (NCI), the Office of Research, Development, and Information (CMS), Information Management Services, Inc., and the SEER Program in the creation of the SEER-Medicare database are acknowledged. Dr. Heather B. Neuman has had full access to all the data in the study and takes full responsibility for the integrity and accuracy of the data and analysis.
This project was funded through the University of Wisconsin Carbone Comprehensive Cancer Center (UWCCC) Academic Oncologist Training Program (NIH 5K12CA087718) and the Building Interdisciplinary Research Careers in Women’s Health Scholar Program (NIH K12 HD055894). Further funding came from contract no. (HHSA290201000006I) from the Agency for Healthcare Research and Quality (AHRQ) as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. Finally, funding support for the SEER-Medicare group came from Grant no. (P30 CA014520) from the National Cancer Institute, the Health Innovation Program, the Community-Academic Partnerships and Biostatistics cores of the University of Wisconsin Institute for Clinical and Translational Research (Grant no. UL1TR0000427 from the Clinical and Translational Science Award program of the National Center for Research Resources, NIH National Center for Advancing Translational Sciences [NCATS]), and the UW School of Medicine and Public Health from The Wisconsin Partnership Program.
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Neuman, H.B., Schumacher, J.R., Schneider, D.F. et al. Variation in the Types of Providers Participating in Breast Cancer Follow-Up Care: A SEER-Medicare Analysis. Ann Surg Oncol 24, 683–691 (2017). https://doi.org/10.1245/s10434-016-5611-7
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DOI: https://doi.org/10.1245/s10434-016-5611-7