title: Health services utilisation in breast cancer survivors in Taiwan.
abstract: Surveillance guidelines for breast cancer survivors recommend regular history and physical and mammography, and against routine imaging for detecting distant metastasis. Stage 0, I, II breast cancer cases treated at a major cancer center were identified from the Taiwan Cancer Registry. We used multivariable negative binomial and logistic regression analyses on institutional claims data to examine factors contributing to utilisation patterns of surveillance visits and tests in disease-free survivors. The mean number of surveillance visits during months 13 to 60 after cancer treatment initiation was 18.5 (SD 8.2) among the 2,090 breast cancer survivors followed for at least five years. After adjusting for patient and disease factors, the number of visits was the highest among patients mainly followed by medical oncologists compared to surgeons and radiation oncologists. Patient cohorts treated in more recent years had lower number of visits associated with care coordination effort, the adjusted mean being 19.2 visits for the 2002 cohort, and 16.3 visits for the 2008 cohort (p < 0.0001). Although imaging tests were highly utilised, there was a significant decrease in tumor marker testing from the 2002 to the 2008 treatment cohort (adjusted rate 99.4% to 35.1% respectively, p < 0.0001) in association with an institutional guideline change.
authors.affiliation: 1] Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA [2] Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA [3] Department of Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Yong A
authors.initials: YA
authors.lastname: Wang
authors.affiliation: Office of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: An-Chen
authors.initials: AC
authors.lastname: Feng
authors.affiliation: 1] Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA [2] Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA [3] Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D012042:Registries; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D013624:Taiwan; D055815:Young Adult