Routine surveillance care after cancer treatment with curative intent.
BACKGROUND
Many consensus guidelines recommend routine surveillance to detect recurrent disease among cancer survivors. We compare surveillance care receipt to guideline recommendations.


METHODS
Cohorts of patients aged 30 years or older diagnosed with breast, colorectal, endometrial, lung, or prostate cancer between 1990 and 1995 and treated with curative intent were identified (n = 100 per site). Receipt and indications for examinations and procedures were abstracted from medical records for as long as 5 years after treatment. Kaplan-Meier product estimates were used to estimate time to initial and subsequent service receipt.


RESULTS
Most cancer patients received the recommended minimum number of physical examinations after treatment. In fact, a sizable number of cancer survivors received physical examinations at a frequency in excess of what is currently recommended. Similarly, most of these cancer survivors received recommended testing for local recurrence. Yet, less than two thirds of colorectal cancer patients received recommended colon examinations in the initial year after treatment. Among colorectal, lung, and prostate cancer patients who received recommended initial local recurrence testing, repeat testing tended to occur more frequently than what is currently recommended. The use of testing for metastatic disease that is not recommended in guidelines is also commonplace among these cancer survivors.


CONCLUSIONS
Among cohorts of cancer patients, we found wide variation in the use of surveillance care, including patterns of care receipt reflective of both underuse and overuse relative to guideline recommendations. Clinical reasons for these variations and the cost and health implications deserve further study.
Elston Lafata
Jennifer
J
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA. jlafata1@hfhs.org
Simpkins
Jan
J
Schultz
Lonni
L
Chase
Gary A
GA
Johnson
Christine Cole
CC
Yood
Marianne Ulcickas
MU
Lamerato
Lois
L
Nathanson
David
D
Cooper
Greg
G
D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015146:Midwestern United States; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010808:Physical Examination / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012042:Registries; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome