title: Quality of cancer survivorship care in the military health system (TRICARE).
abstract: OBJECTIVE
  Following the acute phase of treatment, national guidelines recommend cancer survivors have routine contact with health care providers and undergo basic ancillary testing while avoiding high-cost imaging (HCI). We conducted this study to determine how frequently breast, prostate, and colorectal cancer survivors received recommended follow-up care and HCI tests during the survivorship period.
  
  
  METHODS
  Using administrative data from TRICARE beneficiaries, we identified a cohort of patients who were treated for breast, prostate, or colorectal cancer between October 2005 and March 2007. These patients were then followed through September 2010. During the 3 years after initial treatment, we determined how frequently survivors received all minimum recommended survivorship care as defined by national guidelines and underwent HCI tests and if these outcomes varied by geographic region.
  
  
  RESULTS
  Overall, 3148 patients underwent treatment for breast (n = 1630), prostate (n = 1173), or colorectal (n = 345) cancer. Sixty-five percent received all minimum recommended care over 3 years (breast = 74.1%, prostate = 65.3%, colorectal = 25.5%). During the 3-year period, 74.1% of breast cancer survivors received a mammogram each year, whereas 69.1% of colorectal cancer survivors had at least 1 colonoscopy. Sixty-four percent had at least 1 HCI study during the 3-year period (positron emission tomography = 10.9%, computer tomography = 48.8%, magnetic resonance imaging = 36.6%) at a cost of $3.5 million. Substantial state-level variation was noted for both outcomes.
  
  
  CONCLUSIONS
  Some cancer survivors do not receive recommended care following initial treatment while frequently undergoing HCI. The existing geographic variation in quality and imaging utilization suggests that improvements to cancer survivorship care are possible.
authors: Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors: Justin P
authors: JP
authors: Fox
authors: Diana D
authors: DD
authors: Jeffery
authors: Thomas V
authors: TV
authors: Williams
authors: Cary P
authors: CP
authors: Gross
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000191:economics; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D011159:Population Surveillance; D011787:Quality of Health Care / Q000191:economics; D017741:Survivors