Fostering coordinated survivorship care in breast cancer: who is lost to follow-up?
Fostering coordinated survivorship care in breast cancer: who is lost to follow-up?
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DOI：
10.1007/s11764-013-0323-5
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发表时间：
2014-06-01
影响因子：
3.7
通讯作者：
Edge, Stephen B.
中科院分区：
文献类型：
--
作者：
Kukar, Moshim;Watroba, Nancy;Edge, Stephen B.
癌症幸存者人数的不断增加以及对他们需求的认识超出了复发监测的范围，这使得许多癌症中心的资源捉襟见肘。有时，患者只向肿瘤学家以外的提供者跟进，而没有协调的护理转移计划。方法将1997年7月1日至2010年3月31日期间诊断为乳腺癌的女性患者的记录与2012年3月31日之前的账单数据相关联，以确定最后一次肿瘤学随访的细节。如果患者两年以上没有就诊肿瘤科，则被归类为已转移到中心外的护理。结果3924例乳腺癌患者中，有858例(21.9%)的患者在5年和10年时分别有18%和36%的患者被转移到医院以外的机构。与转移相关的独立因素有：确诊时年龄(单位增长1.01/年)、IIA期(HR 1.30，p=0.02)、到癌症中心较远的车程(HR 1.65，p<；0.01)、癌症复发(HR 0.15 p<；0.01)、最后一次到内科肿瘤科与外科肿瘤科诊所就诊(HR 0.32 p<；0.01)。癌症项目应该建立机制，帮助患者进行护理转移，并确保协调转移到其他提供者，以提高护理的连续性。对癌症幸存者的影响这项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后续治疗的患者群体。前瞻性地，确定哪些患者可能更有可能转移治疗，将提供有效协调治疗后监测和初级护理的机会。
Introduction 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.Methods 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.Results 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).Conclusions 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.Implications for Cancer Survivors 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.