Reduced rates of cancer-related worries and mortality associated with guideline surveillance after breast cancer therapy.
OBJECTIVE
Guidelines have been developed for appropriate post-therapy surveillance for breast cancer recurrence. Two objectives of post-therapy surveillance are to support and counsel patients and to detect potentially curable local recurrences and new cancers in the opposite breast. The objective of this investigation was to assess the impact of guideline surveillance (history, physical examination, and annual mammography) on cancer-related worries and all-cause mortality.


METHODS
We collected data on a cohort of 303 Massachusetts women with stages I or II breast cancer diagnosed between 1992 and 1994. Cases were women with increasing cancer-related worries or decedents. We used risk-set sampling to match five controls to each case on follow-up time. Cases and members of their matched risk set were characterized with respect to receipt of guideline surveillance and covariates preceding the date of their outcomes.


RESULTS
The adjusted odds ratio associating guideline surveillance in the preceding year with an increase in cancer-related worries equaled 0.37 (95% CI = 0.14-0.99). The adjusted odds ratio associating continuous guideline surveillance with all-cause mortality equaled 0.66 (95% CI = 0.51-0.86).


CONCLUSIONS
The results are consistent with the stated objectives of surveillance follow-up of breast cancer patients after the completion of their primary therapy.
Lash
Timothy L
TL
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. tlash@bu.edu
Clough-Gorr
Kerri
K
Silliman
Rebecca A
RA
D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000517:prevention & control; D015996:Survival Rate