title: American Society of Clinical Oncology-recommended surveillance and physician specialty among long-term breast cancer survivors.
abstract: BACKGROUND
  It is unclear whether it is appropriate to transfer the follow-up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long-term surveillance of survivors who underwent surgery at an American academic center.
  
  
  METHODS
  Women in this institutional review board-approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow-up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care.
  
  
  RESULTS
  The majority of patients (90%; n = 242) were followed by specialists with 10% (n = 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO-recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow-up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at Year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%; P = .001-.02).
  
  
  CONCLUSIONS
  Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice.
authors.affiliation: Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Hollowell
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Olmsted
authors.forename: Anne S
authors.initials: AS
authors.lastname: Richardson
authors.forename: H Keith
authors.initials: HK
authors.lastname: Pittman
authors.forename: Lisa
authors.initials: L
authors.lastname: Bellin
authors.forename: Lorraine
authors.initials: L
authors.lastname: Tafra
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Verbanac
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D003266:Continuity of Patient Care; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008327:Mammography; D008495:Medical Oncology; D010821:Physicians, Family; D012189:Retrospective Studies; D012955:Societies, Medical; D017741:Survivors