Simon M S, Hoff M, Hussein M, Martino S, Walt A
Meyer L. Prentis Comprehensive Cancer Center of Metropolitan Detroit, Detroit, MI 48201.
Breast Cancer Res Treat. 1993 Sep;27(3):211-9. doi: 10.1007/BF00665691.
Routine clinical follow-up for distant metastatic disease among women with early stage breast cancer is of uncertain clinical benefit. In order to evaluate current practice patterns, we administered a mailed survey to a stratified random sample of physician members of the American Society of Clinical Oncology (ASCO) (N = 435). The survey assessed the frequency and motivation for ordering follow-up medical tests in asymptomatic postmenopausal women with stage I or II breast cancer. The response rate was 55%, distributed as 39% radiation oncologists, 32% medical oncologists, and 29% surgeons. In the first year after treatment, physicians performed, on average, one physical examination every 3 months, one blood panel (CBC, alkaline phosphatase and liver function tests) every 4 months, and one chest radiograph every 9 months. In addition, 38% of the respondents ordered CEA and 21% ordered CA 15-3 levels, 28% ordered bone scans, and less than 4% ordered CT scans, bone surveys, or bone marrow biopsies in the first year after treatment. A logistic regression analysis controlling for physician age, gender, sub-specialty, practice type, years of experience, number of breast cancer patients treated annually, geographic region, and community size, showed that surgeons were less likely to order blood tests (p < 0.001) and tumor markers (p < 0.0029) than medical oncologists in years 3 and 5 of follow-up. Compared to physicians practicing in the northeast, those from the midwest were less likely to order chest radiographs in year 3 of follow-up (p = 0.0028). Other provider characteristics had no significant effect on test ordering behavior. The results of this survey suggest that relatively uniform practice patterns in regard to the follow-up of postmenopausal women with early stage breast cancer exist among ASCO physicians.
对早期乳腺癌女性进行远处转移性疾病的常规临床随访，其临床获益尚不确定。为评估当前的实践模式，我们对美国临床肿瘤学会（ASCO）的医师会员进行分层随机抽样，并邮寄了一份调查问卷（N = 435）。该调查评估了对无症状的Ⅰ期或Ⅱ期乳腺癌绝经后女性进行随访医学检查的频率和动机。回复率为55%，其中放疗科医生占39%，内科肿瘤医生占32%，外科医生占29%。在治疗后的第一年，医生平均每3个月进行一次体格检查，每4个月进行一次血液检查（全血细胞计数、碱性磷酸酶和肝功能检查），每9个月进行一次胸部X光检查。此外，38%的受访者检测癌胚抗原（CEA），21%检测糖类抗原15-3（CA 15-3）水平，28%进行骨扫描，治疗后第一年进行CT扫描、骨显像或骨髓活检的比例不到4%。一项逻辑回归分析对医生的年龄、性别、亚专业、执业类型、从业年限、每年治疗的乳腺癌患者数量、地理区域和社区规模进行了控制，结果显示在随访的第3年和第5年，外科医生比内科肿瘤医生开具血液检查（p < 0.001）和肿瘤标志物检查（p < 0.0029）的可能性更小。与在东北部执业的医生相比，中西部的医生在随访第3年进行胸部X光检查的可能性更小（p = 0.0028）。其他医生特征对检查开具行为没有显著影响。这项调查结果表明，ASCO医生对早期乳腺癌绝经后女性进行随访的实践模式相对统一。
