Washington University School of Medicine; St Louis University Health Sciences Center; Department of Veterans Affairs Medical Center, St Louis MO; and American Cancer Society, Atlanta GA.
J Oncol Pract. 2012 Mar;8(2):79-83. doi: 10.1200/JOP.2011.000289. Epub 2011 Dec 13.
To determine how physicians monitor their patients after initial curative-intent treatment for breast carcinoma.
A custom-designed survey instrument with four idealized patient vignettes (TNM stages 0 to III) was e-mailed to the 3,245 members of ASCO who had identified themselves as having breast cancer as a major focus of their practice. Respondents were asked how they use 12 specific follow-up modalities during post-treatment years 1 to 5 for each vignette. Mean, median, standard deviation, and range of the intensity of use for each modality were calculated for the four vignettes.
Of the 3,245 ASCO members surveyed, 1,012 (31%) responded. Of these, 915 (90%) were evaluable and were included in our analysis. Office visit, mammogram, complete blood count, and liver function tests were the most commonly recommended surveillance modalities. There was marked variation in surveillance intensity. For example, office visit was recommended 4.1 ± 2.2 times (mean ± SD) in year 1 after curative treatment of a patient with stage III breast cancer. Similar variation was observed for all modalities.
The intensity of post-treatment surveillance performed by ASCO members caring for patients with breast cancer varies markedly despite evidence from well-designed, adequately powered randomized controlled trials. Many modalities not recommended by ASCO guidelines are used routinely, which constitutes evidence of overuse. The lack of consensus is likely due to multiple factors and constitutes an appealing target for interventions to rationalize surveillance.
确定医生在对乳腺癌初始治愈性治疗后如何监测患者。
采用定制的调查问卷，包含四个理想化的患者病例（TNM 分期 0 至 III 期），通过电子邮件发送给 ASCO 的 3245 名成员，这些成员将乳腺癌作为其主要关注的实践领域之一。要求受访者回答在治疗后 1 至 5 年内，针对每个病例，他们如何使用 12 种特定的随访方式。计算了这四种病例中每种方式使用的强度的平均值、中位数、标准差和范围。
在接受调查的 3245 名 ASCO 成员中，有 1012 名（31%）做出了回应。其中，915 名（90%）是可评估的，并纳入了我们的分析。门诊就诊、乳房 X 光检查、全血细胞计数和肝功能检查是最常推荐的监测方式。监测强度存在明显差异。例如，在对 III 期乳腺癌患者进行治愈性治疗后的第一年，推荐进行 4.1 ± 2.2 次（平均值 ± 标准差）的门诊就诊。所有方式都观察到类似的变化。
尽管有设计良好、充分有力的随机对照试验提供证据，但 ASCO 成员在治疗后对乳腺癌患者进行的监测强度存在显著差异。许多 ASCO 指南未推荐的方式被常规使用，这构成了过度使用的证据。缺乏共识可能是由于多种因素造成的，这为干预措施以合理化监测提供了一个有吸引力的目标。
