title: Randomized phase 2 trial of a coordinated breast cancer follow-up care program.
abstract: BACKGROUND
  Previous research has demonstrated that cancer survivors often fail to receive recommended care and also undergo unnecessary care; this reduces care quality and increases costs.
  
  
  METHODS
  This phase 2 trial randomized 100 stage 0 to IIIa breast cancer patients who had primary care providers within a large Massachusetts-based hospital network (with accessible online records) to either coordinated follow-up care (CC), which entailed a tailored survivorship care plan (SCP) and patient navigator calls every 3 months, or standard care (SC), which did not include an SCP or patient navigation, for 1 year after the completion of their last chemotherapy, surgery, or radiation treatment. The primary endpoint was the frequency of redundant examinations (>1 breast/chest wall examination per patient within any 30-day period in the absence of a new breast or chest wall complaint) over the year of follow-up. The total number of non-plastic surgery visits in the year of follow-up was a secondary endpoint.
  
  
  RESULTS
  Two patients (both on CC) were ineligible, and 2 patients (1 per arm) had a recurrence or died during follow-up; this left 96 for analysis (47 in the CC arm and 49 in the SC arm). Twenty-two of the 47 CC patients (47%; 95% confidence interval, 32%-62%) and 19 of the 49 SC patients (39%; 95% confidence interval, 25%-54%) had 1 or more redundant breast/chest wall examinations during the year. The median number of non-plastic surgery visits was 12 for CC patients and 8 for SC patients.
  
  
  CONCLUSIONS
  Early-stage breast cancer patients visit health care providers very frequently during their first year of follow-up and often receive unnecessary breast/chest wall examinations. An SCP and patient navigator calls did not reduce this surrogate for redundant care. Cancer 2016;122:3546-3554. © 2016 American Cancer Society.
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ruddy
authors.affiliation: Department of biostatistics and computational biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Hao
authors.initials: H
authors.lastname: Guo
authors.affiliation: Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Baker
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Goldstein
authors.affiliation: Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Mullaney
authors.affiliation: Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.affiliation: Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
keywords: breast neoplasms; continuity of patient care; delivery of health care; patient care planning; program effectiveness