Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA,
J Cancer Surviv. 2014 Jun;8(2):199-204. doi: 10.1007/s11764-013-0323-5. Epub 2013 Dec 7.
Increasing numbers of cancer survivors and the recognition of their needs beyond recurrence surveillance are stretching resources at many cancer centers. Sometimes, patients solely follow up with providers other than the oncologist without coordinated care transfer plans. This study examines factors associated with transfer of breast cancer survivorship care outside one large cancer center.
Records on women with breast cancer diagnosed between July 1, 1997 and March 31, 2010 were linked to billing data through March 31, 2012 to identify the details of last oncology follow-up. A patient was classified as having transferred care outside the center if there was no oncology visit for more than 2 years. Clinical and pathologic characteristics were examined in a multivariate proportional hazards model to identify factors associated with transfer of care.
Of 3,924 women with breast cancer, 858 (21.9%) transferred care outside of our institution, 18 and 36% at 5 and 10 years, respectively. Factors independently associated with transfer of care were age at diagnosis (unit increase 1.01/year age), stage IIA (HR 1.30, p = 0.02), longer driving distance to the cancer center (HR 1.65, p < 0.01), having had a cancer recurrence (HR 0.15 p < 0.01), and last visit in a medical oncology versus surgical oncology clinic (HR 0.32 p < 0.01).
Many patients with breast cancer do not continue oncology follow-up after treatment. Cancer programs should develop mechanisms to assist patients with care transfer and assure coordinated transfer to other providers to improve continuity of care.
The results of this study will help the cancer centers identify the population of patients that are most likely to transfer care or become lost to follow up. Prospectively, identifying patients who may be more likely to transfer care will offer opportunities to effectively coordinate posttreatment surveillance with primary care.
随着癌症幸存者人数的增加，以及对他们在复发监测之外的需求的认识不断提高，许多癌症中心的资源都面临压力。有时，患者只在没有协调的护理转移计划的情况下，跟随除肿瘤医生以外的提供者进行后续治疗。本研究探讨了与大型癌症中心之外的乳腺癌生存者护理转移相关的因素。
通过链接 1997 年 7 月 1 日至 2010 年 3 月 31 日期间确诊的乳腺癌女性的记录和 2012 年 3 月 31 日之前的计费数据，确定最后一次肿瘤学随访的详细信息。如果患者超过 2 年没有进行肿瘤学就诊，则将其归类为在中心以外接受治疗。在多变量比例风险模型中检查临床和病理特征，以确定与护理转移相关的因素。
在 3924 名乳腺癌患者中，有 858 名（21.9%）将护理转移到我们机构之外，分别在第 5 年和第 10 年的转移比例为 18%和 36%。与护理转移独立相关的因素包括诊断时的年龄（每年增加 1.01 岁）、IIA 期（HR 1.30，p=0.02）、到癌症中心的驾驶距离较长（HR 1.65，p<0.01）、癌症复发（HR 0.15，p<0.01）以及最后一次就诊是在医学肿瘤学诊所还是外科肿瘤学诊所（HR 0.32，p<0.01）。
许多乳腺癌患者在治疗后不再进行肿瘤学随访。癌症项目应制定机制，帮助患者进行护理转移，并确保将其转移到其他提供者，以改善护理的连续性。
本研究的结果将帮助癌症中心确定最有可能转移护理或失去随访的患者人群。前瞻性地，识别可能更倾向于转移护理的患者将为有效协调治疗后监测与初级保健提供机会。
