title: Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent.
abstract: BACKGROUND
  Evidence-based guidelines recommend routine surveillance, including office visits and testing, to detect new and recurrent disease among survivors of breast and colorectal cancer. The extent to which surveillance practice is consistent with guideline recommendations or may vary by age is not known.
  
  
  METHODS
  Cohorts of adult patients diagnosed with breast (n = 6205) and colorectal (n = 2297) cancer between 2000 and 2008 and treated with curative intent in 4 geographically diverse managed care environments were identified via tumor registries. Kaplan-Meier estimates were used to describe time to initial and subsequent receipt of surveillance services. Cox proportional hazards models evaluated the relation between patient characteristics and receipt of metastatic screening.
  
  
  RESULTS
  Within 18 months of treatment, 87.2% of breast cancer survivors received recommended mammograms, with significantly higher rates noted for patients aged 50 years to 65 years. Among survivors of colorectal cancer, only 55.0% received recommended colon examinations, with significantly lower rates for those aged ≥ 75 years. The majority of breast (64.7%) and colorectal (73.3%) cancer survivors received nonrecommended metastatic disease testing. In patients with breast cancer, factors associated with metastatic disease testing include white race (hazards ratio [HR], 1.13), comorbidities (HR, 1.17), and younger age (HR, 1.13; 1.15; 1.13 for age groups: <50, 50-64, and 65-74 respectively). In those with colorectal cancer, these factors included younger age (HR, 1.31; 1.25 for age groups: <50 and 50-64 respectively) and comorbidities (HR, 1.10).
  
  
  CONCLUSIONS
  Among an insured population, wide variation regarding the use of surveillance care was found by age and relative to guideline recommendations. Breast cancer survivors were found to have high rates of both guideline-recommended recurrence testing and non-guideline-recommended metastatic testing. Only approximately 50% of colorectal cancer survivors received recommended tests but greater than 67% received metastatic testing.
authors.affiliation: Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. ramzi.salloum@unc.edu
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
authors.forename: Maureen C
authors.initials: MC
authors.lastname: O'Keeffe Rossetti
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston Lafata
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000517:prevention & control*; D009819:Office Visits; D010349:Patient Compliance; D010808:Physical Examination; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D017741:Survivors