Ontario Institute for Cancer Research; Cancer Care Ontario Health Services Research Program; Department of Family and Community Medicine, University of Toronto; Institute of Clinical Evaluative Sciences, Sunnybrook Health Science Centre; Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
J Oncol Pract. 2010 Jul;6(4):174-81. doi: 10.1200/JOP.200009.
To describe the patterns of follow-up care provided to a population-based cohort of breast cancer survivors, and to assess factors associated with adherence to guidelines on follow-up care.
We conducted a retrospective longitudinal study of all women with surgically treated breast cancer who were without evidence of recurrence, advanced breast cancer, or new primary cancer and were diagnosed in Ontario, Canada, within a 2-year period (n = 11,219). They were followed for 5 years. The cohort was identified through the Ontario Cancer Registry, and individuals were linked across population-based administrative health databases. Frequency of and adherence to guideline recommendations for oncologist and primary care physician (PCP) visits; surveillance imaging for metastatic disease; and surveillance mammograms by year from diagnosis, age group, and income quintile were analyzed. Factors associated with adherence to guideline recommendations were analyzed.
Most women saw both oncologists and PCPs in each follow-up year. Approximately two thirds had surveillance mammograms in each follow-up year. Overall, two thirds had either fewer or greater than recommended oncology visits, one quarter had fewer than recommended surveillance mammograms, and half had greater than recommended surveillance imaging for metastatic disease.
This population-based study shows substantial variation in adherence to guideline recommendations, with both overuse and underuse of surveillance visits and tests. Most importantly, a substantial proportion are receiving more than recommended imaging for metastatic disease but fewer than recommended mammograms for detection of local recurrence or new primary cancer, for which effective intervention is possible.
描述为基于人群的乳腺癌幸存者队列提供的随访护理模式，并评估与随访护理指南依从性相关的因素。
我们对所有在加拿大安大略省接受过手术治疗且无复发、晚期乳腺癌或新发原发性癌症证据的乳腺癌女性患者进行了回顾性纵向研究，这些患者在 2 年内被诊断（n=11219）。对患者进行了 5 年的随访。该队列是通过安大略癌症登记处确定的，个体通过基于人群的行政健康数据库进行链接。分析了每年、每个年龄组和每个收入五分位数的肿瘤科医生和初级保健医生（PCP）就诊、转移性疾病监测成像和监测乳房 X 光检查的频率和对指南建议的依从性；分析了与依从性指南建议相关的因素。
大多数女性在每个随访年都会看肿瘤科医生和 PCP。大约三分之二的患者在每个随访年都进行了乳房 X 光检查。总体而言，三分之二的患者接受的肿瘤学就诊次数少于或多于建议次数，四分之一的患者接受的乳房 X 光检查次数少于建议次数，一半的患者接受的转移性疾病监测成像次数多于建议次数。
这项基于人群的研究表明，在遵循指南建议方面存在很大的差异，包括对监测就诊和检查的过度使用和不足使用。最重要的是，相当一部分患者接受了比建议更多的转移性疾病影像学检查，但接受的用于检测局部复发或新发原发性癌症的乳房 X 光检查却少于建议次数，而对于这些疾病，有效的干预是可能的。
