Cooper Gregory S, Johnson Christine Cole, Lamerato Lois, Poisson Laila M, Schultz Lonni, Simpkins Jan, Wells Karen, Yood Marianne Ulcickas, Chase Gary, Nathanson S David, Lafata Jennifer Elston
Division of Gastroenterology and Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106-5066, USA.
Med Care. 2006 Jun;44(6):590-4. doi: 10.1097/01.mlr.0000215902.50543.77.
After potentially curative cancer treatment, patients may receive procedures for routine monitoring for recurrence or for evaluation of symptoms or signs.
We sought to characterize surveillance care guideline-recommended and other procedures performed in cancer survivors according to routine versus diagnostic indications.
This was a retrospective cohort study of paper and electronic medical records between 1990 and 2000 from a large midwestern U.S. integrated health care delivery system of 500 patients who received curative treatment of breast, colorectal, endometrial, lung, or prostate cancer. Our measures were the indications for potential surveillance procedures as recommended by clinical practice guidelines or otherwise.
Among 14,670 procedures of interest received, 82.0% were performed for routine surveillance, whereas 10.6% were performed for diagnostic indications and 7.3% had indeterminate indications. Office visits most were often delivered for routine indications (91.6%), followed by guideline recommended tests for local recurrence (range 74.1-98.4%, depending on the specific test and cancer). In general, tests that were not recommended in established guidelines were for the purposes of detection of metastatic recurrence and were less often delivered for routine indications (overall frequency 59.2%, P<0.0001 compared with recommended testing).
Office visits and testing for local recurrence of cancer generally are performed for routine surveillance, regardless of recommendation by practice guidelines. Because procedures not recommended by practice guidelines were more often for diagnostic purposes, classification of patients as undergoing intensive surveillance may be misleading and may require record review to confirm.
在接受了可能治愈性的癌症治疗后，患者可能会接受一些程序进行复发的常规监测或症状体征的评估。
我们试图根据常规与诊断指征，对癌症幸存者中监测护理指南推荐的以及其他进行的程序进行特征描述。
这是一项回顾性队列研究，研究对象为1990年至2000年间来自美国中西部一个大型综合医疗保健系统的纸质和电子病历，该系统中有500名接受了乳腺癌、结直肠癌、子宫内膜癌、肺癌或前列腺癌治愈性治疗的患者。我们的衡量指标是临床实践指南推荐的或其他潜在监测程序的指征。
在接受的14670项相关程序中，82.0%是为了常规监测而进行的，而10.6%是为了诊断指征进行的，7.3%的指征不明确。门诊就诊大多是出于常规指征（91.6%），其次是指南推荐的局部复发检测（范围为74.1%-98.4%，取决于具体检测和癌症类型）。一般来说，既定指南中未推荐的检测是为了检测转移性复发，且较少用于常规指征（总体频率为59.2%，与推荐检测相比，P<0.0001）。
无论实践指南是否推荐，癌症局部复发的门诊就诊和检测通常是为了常规监测而进行的。由于实践指南未推荐的程序更多是用于诊断目的，将患者分类为接受强化监测可能会产生误导，可能需要查阅记录来确认。
