Population-Based Longitudinal Study of Follow-Up Care for Breast Cancer Survivors
Population-Based Longitudinal Study of Follow-Up Care for Breast Cancer Survivors
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DOI：
10.1200/jop.200009
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发表时间：
2010-07-01
影响因子：
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通讯作者：
Moineddin, Rahim
中科院分区：
文献类型：
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作者：
Grunfeld, Eva;Hodgson, David C.;Moineddin, Rahim
目的：描述对一个以人群为基础的乳腺癌幸存者队列提供的随访护理模式，并评估与随访护理指南依从性相关的因素。我们对所有在加拿大安大略确诊的经手术治疗的乳腺癌女性进行了一项回顾性纵向研究，这些女性没有复发、晚期乳腺癌或新的原发癌的证据，2年内（n = 11，219）。他们被跟踪了5年。通过安大略癌症登记处确定了该队列，并将个体与基于人口的行政健康数据库相关联。分析了肿瘤科医生和初级保健医生（PCP）访视的频率和遵守指南建议的情况;转移性疾病的监测成像;以及从诊断开始按年、年龄组和收入五分位数进行的监测乳房X线照片。与遵守指南recommendations.Results：大多数妇女都看到了肿瘤学家和PCP在每个后续年的相关因素进行了分析。大约三分之二的人在每个随访年都有监测乳房X线照片。总体而言，三分之二的人或少或多推荐的肿瘤就诊，四分之一的人少于推荐的监测乳房X线检查，一半大于推荐的监测成像转移diseases.Conclusion：这项以人群为基础的研究表明，在遵守指南的建议，过度使用和使用不足的监测访问和测试的重大变化。最重要的是，很大一部分人接受的转移性疾病的影像检查超过了推荐的影像检查，但接受的局部复发或新原发性癌症的检测却少于推荐的乳房X线检查，而这些癌症是可能进行有效干预的。
Purpose: To describe the patterns of follow-up care provided to a population-based cohort of breast cancer survivors, and to assess factors associated with adherence to guidelines on follow-up care.Patients and Methods: We conducted a retrospective longitudinal study of all women with surgically treated breast cancer who were without evidence of recurrence, advanced breast cancer, or new primary cancer and were diagnosed in Ontario, Canada, within a 2-year period (n = 11,219). They were followed for 5 years. The cohort was identified through the Ontario Cancer Registry, and individuals were linked across population-based administrative health databases. Frequency of and adherence to guideline recommendations for oncologist and primary care physician (PCP) visits; surveillance imaging for metastatic disease; and surveillance mammograms by year from diagnosis, age group, and income quintile were analyzed. Factors associated with adherence to guideline recommendations were analyzed.Results: Most women saw both oncologists and PCPs in each follow-up year. Approximately two thirds had surveillance mammograms in each follow-up year. Overall, two thirds had either fewer or greater than recommended oncology visits, one quarter had fewer than recommended surveillance mammograms, and half had greater than recommended surveillance imaging for metastatic disease.Conclusion: This population-based study shows substantial variation in adherence to guideline recommendations, with both overuse and underuse of surveillance visits and tests. Most importantly, a substantial proportion are receiving more than recommended imaging for metastatic disease but fewer than recommended mammograms for detection of local recurrence or new primary cancer, for which effective intervention is possible.