Neuman Heather B, Schumacher Jessica R, Schneider David F, Winslow Emily R, Busch Rebecca A, Tucholka Jennifer L, Smith Maureen A, Greenberg Caprice C
Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ann Surg Oncol. 2017 Mar;24(3):683-691. doi: 10.1245/s10434-016-5611-7. Epub 2016 Oct 5.
The current guidelines do not delineate the types of providers that should participate in early breast cancer follow-up care (within 3 years after completion of treatment). This study aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors and to identify factors associated with receipt of follow-up care from different types of providers.
Stages 1-3 breast cancer survivors treated from 2000 to 2007 were identified in the Surveillance, Epidemiology and End results Medicare database (n = 44,306). Oncologist (including medical, radiation, and surgical) follow-up and primary care visits were defined using Medicare specialty provider codes and linked American Medical Association (AMA) Masterfile. The types of providers involved in follow-up care were summarized. Stepped regression models identified factors associated with receipt of medical oncology follow-up care and factors associated with receipt of medical oncology care alone versus combination oncology follow-up care.
Oncology follow-up care was provided for 80 % of the patients: 80 % with a medical oncologist, 46 % with a surgeon, and 39 % with a radiation oncologist after radiation treatment. The patients with larger tumor size, positive axillary nodes, estrogen receptor (ER)-positive status, and chemotherapy treatment were more likely to have medical oncology follow-up care than older patients with higher Charlson comorbidity scores who were not receiving axillary care. The only factor associated with increased likelihood of follow-up care with a combination of oncology providers was regular primary care visits (>2 visits/year).
Substantial variation exists in the types of providers that participate in breast cancer follow-up care. Improved guidance for the types of providers involved and delineation of providers' responsibilities during follow-up care could lead to improved efficiency and quality of care.
当前指南未明确指出应参与早期乳腺癌后续治疗（治疗结束后3年内）的医疗服务提供者类型。本研究旨在描述参与老年乳腺癌幸存者早期后续治疗的医疗服务提供者类型，并确定与接受不同类型医疗服务提供者后续治疗相关的因素。
在监测、流行病学和最终结果医疗保险数据库中识别出2000年至2007年接受治疗的1 - 3期乳腺癌幸存者（n = 44306）。使用医疗保险专科提供者代码和关联的美国医学协会（AMA）主文件来定义肿瘤学家（包括医学、放射和外科）的随访以及初级保健就诊。总结参与后续治疗的医疗服务提供者类型。逐步回归模型确定与接受医学肿瘤学随访治疗相关的因素，以及与仅接受医学肿瘤学治疗相比接受联合肿瘤学随访治疗相关的因素。
80%的患者接受了肿瘤学随访治疗：放疗后，80%的患者接受医学肿瘤学家随访，46%的患者接受外科医生随访，39%的患者接受放射肿瘤学家随访。与未接受腋窝治疗且Charlson合并症评分较高的老年患者相比，肿瘤体积较大、腋窝淋巴结阳性、雌激素受体（ER）阳性状态以及接受化疗的患者更有可能接受医学肿瘤学随访治疗。与联合肿瘤学提供者进行随访治疗可能性增加相关的唯一因素是定期初级保健就诊（>每年2次就诊）。
参与乳腺癌后续治疗的医疗服务提供者类型存在很大差异。改善对参与医疗服务提供者类型的指导以及明确后续治疗期间医疗服务提供者的职责，可能会提高治疗效率和质量。
