title: Use of guideline recommended follow-up care in cancer survivors: routine or diagnostic indications?
abstract: BACKGROUND
  After potentially curative cancer treatment, patients may receive procedures for routine monitoring for recurrence or for evaluation of symptoms or signs.
  
  
  OBJECTIVE
  We sought to characterize surveillance care guideline-recommended and other procedures performed in cancer survivors according to routine versus diagnostic indications.
  
  
  METHODS
  This was a retrospective cohort study of paper and electronic medical records between 1990 and 2000 from a large midwestern U.S. integrated health care delivery system of 500 patients who received curative treatment of breast, colorectal, endometrial, lung, or prostate cancer. Our measures were the indications for potential surveillance procedures as recommended by clinical practice guidelines or otherwise.
  
  
  RESULTS
  Among 14,670 procedures of interest received, 82.0% were performed for routine surveillance, whereas 10.6% were performed for diagnostic indications and 7.3% had indeterminate indications. Office visits most were often delivered for routine indications (91.6%), followed by guideline recommended tests for local recurrence (range 74.1-98.4%, depending on the specific test and cancer). In general, tests that were not recommended in established guidelines were for the purposes of detection of metastatic recurrence and were less often delivered for routine indications (overall frequency 59.2%, P<0.0001 compared with recommended testing).
  
  
  CONCLUSIONS
  Office visits and testing for local recurrence of cancer generally are performed for routine surveillance, regardless of recommendation by practice guidelines. Because procedures not recommended by practice guidelines were more often for diagnostic purposes, classification of patients as undergoing intensive surveillance may be misleading and may require record review to confirm.
authors.affiliation: Division of Gastroenterology and Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106-5066, USA. Greg.Cooper@cwru.edu
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Laila M
authors.initials: LM
authors.lastname: Poisson
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.forename: Jan
authors.initials: J
authors.lastname: Simpkins
authors.forename: Karen
authors.initials: K
authors.lastname: Wells
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Gary
authors.initials: G
authors.lastname: Chase
authors.forename: S David
authors.initials: SD
authors.lastname: Nathanson
authors.forename: Jennifer Elston
authors.initials: JE
authors.lastname: Lafata
mesh_terms: D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data*