Variation in Provider Breast Cancer Surveillance Strategies Following Initial Treatment: Contribution of Patient and Provider Factors, Association with Outcomes, and Stakeholder Insights

初始治疗后提供者乳腺癌监测策略的变化：患者和提供者因素的贡献、与结果的关联以及利益相关者的见解

• 批准号: 9348618
• 负责人: R. Adams Dudley
• 金额: $ 39.93万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348618
• 关键词: Variation; Provider; Breast; Cancer; Surveillance

PROJECT SUMMARY/ABSTRACT For the 3 million patients with breast cancer who have survived the initial treatment phase, routine surveillance for recurrence does not improve outcomes. Although it is possible, using imaging or blood tests, to find cancer recurrence before it produces symptoms or signs, large randomized controlled trials and Cochrane database systematic reviews have found that such surveillance offers no benefit in terms of survival or quality of life for patients with breast cancer. Testing, if unwarranted, involves unnecessary risks to the patient including radiation exposure, patient anxiety, and potential false positives resulting in unnecessary work-up that carries its own risks. Despite the evidence and guidelines advising against it, there is evidence that surveillance testing often occurs after initial treatment of breast cancer. Recent single institution and group model HMO studies and an older national study found evidence of that advanced imaging is used in about half of patients with early stage breast cancers. There is little information about surveillance using blood tests for tumor markers. Our long-term goal is to develop an improved understanding of drivers of surveillance test use and its impact on outcomes and to identify potential interventions to steer provider and patient behavior to improved outcomes and reduced cost (financial and radiation risk). Once the significant drivers of surveillance test use are identified, this information can be used to improve value of care in at least three ways. First, patients will have a better understanding of the potential risks—in terms of cost and radiation exposure—associated with surveillance testing. Second, since the US spends over $4 billion per year on imaging and other tests related to cancer care, even a small reduction in the utilization of expensive unnecessary surveillance tests would represent significant financial savings without increasing mortality. Third, if providers understand the effect, or lack of effect, of modern methods of surveillance testing on patient outcomes, including financial burden, radiation risk, and mortality, their willingness to adhere to guidelines, and patient outcomes, could improve. In this project we will create estimates of the variation in surveillance testing use nationally, and will generate the first data regarding the association between provider characteristics and practice patterns and surveillance testing rates (Aims 1 and 3). We will provide the first data on the impact of surveillance on patient and societal outcomes, for the first time estimating the costs of and radiation exposure due to testing done that is not consistent with guidelines (Aim 2 and 4). Finally, we will create the first qualitative data to allow us to generate hypotheses about why surveillance occurs, which could be used to develop interventions to reduce unnecessary testing that can be tested in future randomized trials.

项目概要/摘要 对于 300 万在初始治疗阶段幸存下来的乳腺癌患者来说，常规治疗 监测复发并不能改善结果。尽管可以通过成像或血液测试来 在癌症出现症状或体征之前发现癌症复发、大型随机对照试验和 Cochrane 数据库系统审查发现，此类监测对生存或质量没有任何好处 乳腺癌患者的生活。如果没有根据，测试会给患者带来不必要的风险 包括辐射暴露、患者焦虑以及导致不必要检查的潜在误报 这有其自身的风险。 尽管有证据和指南建议反对，但有证据表明监测测试经常 发生在乳腺癌初步治疗后。最近的单一机构和团体模型 HMO 研究以及 较早的国家研究发现证据表明，大约一半的早期患者使用了先进的成像技术 乳腺癌。关于使用血液检测肿瘤标志物进行监测的信息很少。 我们的长期目标是更好地了解监视测试使用的驱动因素及其 对结果的影响并确定潜在的干预措施以引导提供者和患者的行为得到改善 结果并降低成本（财务和辐射风险）。一旦监测测试使用的重要驱动因素 一旦确定，该信息可用于至少通过三种方式提高护理价值。首先，患者会 更好地了解与相关的潜在风险（在成本和辐射暴露方面） 监视测试。其次，由于美国每年在成像和其他相关测试上花费超过 40 亿美元 癌症护理，即使少量减少昂贵的不必要的监测测试的使用也会 在不增加死亡率的情况下节省大量资金。第三，如果提供者了解其影响，或者 缺乏对患者结果（包括经济负担）进行监测的现代方法的效果， 辐射风险、死亡率、遵守指南的意愿以及患者的治疗结果都可以得到改善。 在这个项目中，我们将对全国监测测试使用的变化进行估计，并将 生成有关提供者特征和实践模式之间关联的第一个数据，并且 监督检测率（目标 1 和 3）。我们将提供有关监测对患者影响的第一批数据 和社会成果，首次估计了由于进行的测试而造成的成本和辐射暴露 与指南（目标 2 和 4）不一致。最后，我们将创建第一个定性数据，使我们能够 产生关于监视发生原因的假设，这可用于制定干预措施以减少 不必要的测试可以在未来的随机试验中进行测试。