Ruddy Kathryn J, Guo Hao, Baker Emily L, Goldstein Matthew J, Mullaney Erin E, Shulman Lawrence N, Partridge Ann H
Department of Oncology, Mayo Clinic, Rochester, Minnesota.
Department of biostatistics and computational biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2016 Nov 15;122(22):3546-3554. doi: 10.1002/cncr.30206. Epub 2016 Jul 26.
Previous research has demonstrated that cancer survivors often fail to receive recommended care and also undergo unnecessary care; this reduces care quality and increases costs.
This phase 2 trial randomized 100 stage 0 to IIIa breast cancer patients who had primary care providers within a large Massachusetts-based hospital network (with accessible online records) to either coordinated follow-up care (CC), which entailed a tailored survivorship care plan (SCP) and patient navigator calls every 3 months, or standard care (SC), which did not include an SCP or patient navigation, for 1 year after the completion of their last chemotherapy, surgery, or radiation treatment. The primary endpoint was the frequency of redundant examinations (>1 breast/chest wall examination per patient within any 30-day period in the absence of a new breast or chest wall complaint) over the year of follow-up. The total number of non-plastic surgery visits in the year of follow-up was a secondary endpoint.
Two patients (both on CC) were ineligible, and 2 patients (1 per arm) had a recurrence or died during follow-up; this left 96 for analysis (47 in the CC arm and 49 in the SC arm). Twenty-two of the 47 CC patients (47%; 95% confidence interval, 32%-62%) and 19 of the 49 SC patients (39%; 95% confidence interval, 25%-54%) had 1 or more redundant breast/chest wall examinations during the year. The median number of non-plastic surgery visits was 12 for CC patients and 8 for SC patients.
Early-stage breast cancer patients visit health care providers very frequently during their first year of follow-up and often receive unnecessary breast/chest wall examinations. An SCP and patient navigator calls did not reduce this surrogate for redundant care. Cancer 2016;122:3546-3554. © 2016 American Cancer Society.
先前的研究表明，癌症幸存者常常无法获得推荐的护理，同时还会接受不必要的护理；这降低了护理质量并增加了成本。
这项2期试验将100例0至IIIa期乳腺癌患者随机分组，这些患者在马萨诸塞州一家大型医院网络中有初级护理提供者（可获取在线记录），分为协调随访护理（CC）组和标准护理（SC）组。CC组在其最后一次化疗、手术或放疗结束后1年，接受定制的生存护理计划（SCP）并每3个月由患者导航员进行电话随访；SC组不包括SCP或患者导航服务。主要终点是随访1年期间重复检查的频率（在没有新的乳房或胸壁问题的情况下，任何30天内每位患者进行超过1次乳房/胸壁检查）。随访1年期间非整形手术就诊的总数是次要终点。
2例患者（均在CC组）不符合条件，2例患者（每组各1例）在随访期间复发或死亡；剩余96例用于分析（CC组47例，SC组49例）。47例CC组患者中有22例（47%；95%置信区间，32%-62%），49例SC组患者中有19例（39%；95%置信区间，25%-54%）在这一年中进行了1次或更多次重复的乳房/胸壁检查。CC组患者非整形手术就诊的中位数为12次，SC组患者为8次。
早期乳腺癌患者在随访的第一年非常频繁地就诊于医疗保健提供者，并且经常接受不必要的乳房/胸壁检查。SCP和患者导航员电话随访并未减少这种多余护理的替代指标。《癌症》2016年；122：3546 - 3554。©2016美国癌症协会。
