title: Variation in the Types of Providers Participating in Breast Cancer Follow-Up Care: A SEER-Medicare Analysis.
abstract: BACKGROUND
  The current guidelines do not delineate the types of providers that should participate in early breast cancer follow-up care (within 3 years after completion of treatment). This study aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors and to identify factors associated with receipt of follow-up care from different types of providers.
  
  
  METHODS
  Stages 1-3 breast cancer survivors treated from 2000 to 2007 were identified in the Surveillance, Epidemiology and End results Medicare database (n = 44,306). Oncologist (including medical, radiation, and surgical) follow-up and primary care visits were defined using Medicare specialty provider codes and linked American Medical Association (AMA) Masterfile. The types of providers involved in follow-up care were summarized. Stepped regression models identified factors associated with receipt of medical oncology follow-up care and factors associated with receipt of medical oncology care alone versus combination oncology follow-up care.
  
  
  RESULTS
  Oncology follow-up care was provided for 80 % of the patients: 80 % with a medical oncologist, 46 % with a surgeon, and 39 % with a radiation oncologist after radiation treatment. The patients with larger tumor size, positive axillary nodes, estrogen receptor (ER)-positive status, and chemotherapy treatment were more likely to have medical oncology follow-up care than older patients with higher Charlson comorbidity scores who were not receiving axillary care. The only factor associated with increased likelihood of follow-up care with a combination of oncology providers was regular primary care visits (>2 visits/year).
  
  
  CONCLUSIONS
  Substantial variation exists in the types of providers that participate in breast cancer follow-up care. Improved guidance for the types of providers involved and delineation of providers' responsibilities during follow-up care could lead to improved efficiency and quality of care.
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.|University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Busch
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Tucholka
authors.affiliation: University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|Department of Population Health Sciences, UW Madison School of Medicine and Public Health, Madison, WI, USA.|Department of Family Medicine, UW Madison School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008495:Medical Oncology / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D011960:Receptors, Estrogen / Q000378:metabolism; D018426:SEER Program; D000071077:Surgical Oncology / Q000706:statistics & numerical data*; D013997:Time Factors; D047368:Tumor Burden; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D011960:Receptors, Estrogen