Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors.
BACKGROUND
Although recommendations for breast cancer follow-up frequency exist, current follow-up guidelines are standardized, without consideration of individual patient characteristics. Some studies suggest oncologists are using these characteristics to tailor follow-up recommendations, but it is unclear how this is translating into practice. The objective of this study was to examine current patterns of oncologist breast cancer follow-up and determine the association between patient and tumor characteristics and follow-up frequency.


METHODS
The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify stage I-III breast cancer patients diagnosed 2000-2007 (n = 39,241). Oncologist follow-up visits were defined using Medicare specialty provider codes and the linked AMA Masterfile. Multinomial logistic regression determined the association between patient and tumor characteristics and oncologist follow-up visit frequency.


RESULTS
Younger age (p < 0.001), positive nodes (p < 0.001), estrogen receptor/progesterone receptor positivity (p < 0.001), and increasing treatment intensity (p < 0.001) were most strongly associated with more frequent follow-up. However, after accounting for these characteristics, significant variation in follow-up frequency was observed. In addition to patient factors, the number and types of oncologists involved in follow-up were associated with follow-up frequency (p < 0.001). Types of oncologists providing follow-up varied, with medical oncologists the sole providers of follow-up for 19-51 % of breast cancer survivors. Overall, 58 % of patients received surgical oncology, and 51 % undergoing radiation received radiation oncology follow-up, usually in combination with medical oncology.


CONCLUSIONS
Significant variation in breast cancer follow-up frequency exists. Developing follow-up guidelines tailored for patient, tumor, and treatment characteristics while also providing guidance on who should provide follow-up has the potential to increase clinical efficiency.
Department of Surgery, UW Madison School of Medicine and Public Health, CSC H4/726, 600 Highland Ave., Madison, WI, USA, neuman@surgery.wisc.edu.
Heather B
HB
Neuman
Jennifer M
JM
Weiss
Deborah
D
Schrag
Katie
K
Ronk
Jeffrey
J
Havlena
Noelle K
NK
LoConte
Maureen A
MA
Smith
Caprice C
CC
Greenberg
D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000628:therapy*; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008495:Medical Oncology; D060787:Neoplasm Grading; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D017741:Survivors
D014408:Biomarkers, Tumor