1 Columbia University College of Physicians and Surgeons, New York, NY.
2 Columbia University Mailman School of Public Health, New York, NY.
J Oncol Pract. 2019 Jan;15(1):e1-e9. doi: 10.1200/JOP.18.00229. Epub 2018 Nov 8.
Follow-up guidelines vary widely among national organizations for patients with early-stage breast cancer treated with curative intent. We sought to evaluate the patterns and predictors of provider follow-up care within the first 5 years after diagnosis.
Using the SEER-Medicare linked data set, we evaluated patients who were diagnosed with stage I and II breast cancer who underwent breast-conserving surgery from 2002 to 2007 with follow-up until 2012. We defined discontinuation of follow-up as > 12 months from the previous physician visit without a visit claim from either a surgeon, medical oncologist, or radiation oncologist. We performed a multivariable logistic regression and Cox proportional hazards regression analysis to determine factors associated with the discontinuation of follow-up care.
Of the 30,053 patients enrolled in our initial cohort, 25,781 (85.8%) saw a medical oncologist and 21,612 (71.9%) saw a radiation oncologist in the first year in addition to a surgeon. Over the 5 years, 6,302 patients (21.0%) discontinued follow-up visits. Discontinuation of physician visits increased with increasing age. Women with stage II cancer ( v stage I) were less likely to discontinue follow-up visits (odds ratio, 0.78; 95% CI, 0.73 to 0.83). Time to early discontinuation was greater for patients with hormone receptor-negative tumors (hazard ratio, 1.14; 95% CI, 1.05 to 1.24). Women who were diagnosed more recently were less likely to discontinue seeing any physician.
Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.
针对接受根治性治疗的早期乳腺癌患者，不同国家组织的随访指南差异很大。我们旨在评估诊断后 5 年内提供的随访护理模式和预测因素。
我们使用 SEER-Medicare 关联数据集，评估了 2002 年至 2007 年期间接受保乳手术且随访至 2012 年的 I 期和 II 期乳腺癌患者。我们将随访中断定义为距离上次就诊超过 12 个月，且外科医生、内科肿瘤医生或放射肿瘤医生均未就诊。我们进行了多变量逻辑回归和 Cox 比例风险回归分析，以确定与随访护理中断相关的因素。
在我们最初的队列中，有 30053 名患者，其中 25781 名（85.8%）在第一年就诊时除了外科医生外还看了内科肿瘤医生，21612 名（71.9%）看了放射肿瘤医生。在 5 年内，有 6302 名患者（21.0%）停止了随访就诊。随着年龄的增长，停止看医生的情况越来越多。与 I 期相比，II 期癌症患者（v 期 I 期）不太可能停止随访就诊（优势比，0.78；95%置信区间，0.73 至 0.83）。激素受体阴性肿瘤患者的早期中断时间更长（风险比，1.14；95%置信区间，1.05 至 1.24）。最近被诊断出的患者不太可能停止看任何医生。
在诊断后 5 年内，21%的早期乳腺癌患者停止看任何肿瘤医生。肿瘤专家之间的随访护理协调可能会降低中断率并提高临床效率。
