title: Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers.
abstract: OBJECTIVE
  Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors.
  
  
  METHODS
  Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients' beliefs were compared by provider type using multivariate logistic regression.
  
  
  RESULTS
  No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5-5.8; and other blood tests: OR = 2.0, 95 % CI 1.1-3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity.
  
  
  CONCLUSIONS
  Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type.
  
  
  CONCLUSIONS
  Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA. betsy.risendal@ucdenver.edu.
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Risendal
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sedjo
authors.affiliation: Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, USA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Giuliano
authors.affiliation: Department of Health Outcomes and Behavior, H Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Vadaparampil
authors.affiliation: Department of Health Outcomes and Behavior, H Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.affiliation: Department of Psychology, University of Colorado Denver, Downtown Campus, North Classroom, 5002-M, Denver, CO, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kilbourn
authors.affiliation: Department of Biostatistics and Informatics, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Barón
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Byers
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D013038:Specialization / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D000078329:Workforce
keywords: American Society of Clinical Oncology (ASCO)-recommended surveillance tests; Beliefs; Breast cancer; Prospective study; Provider type; Women