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: 9215587
• 负责人: R. Adams Dudley
• 金额: $ 40万
• 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/9215587
• 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.

项目摘要/摘要 对于在初始治疗阶段幸存下来的300万乳腺癌患者 复发的监视并不能改善预后。尽管有可能使用成像或血液检查，但 在产生症状或体征，大型随机对照试验和Cochrane之前找到癌症复发 数据库系统评价发现，这种监视在生存或质量方面没有任何好处 乳腺癌患者的生命。测试，如果不根据，则涉及患者不必要的风险 包括辐射暴露，患者动画和潜在的误报，导致不必要的检查 这有自己的风险。 尽管有证据和指南讨论了它，但有证据表明经常进行监视测试 在初次治疗乳腺癌后发生。最近的单一机构和小组模型HMO研究以及 较旧的国家研究发现，大约一半的早期患者使用了高级成像的证据 乳腺癌。使用血液测试对肿瘤标志物进行监测的信息很少。 我们的长期目标是对监视测试使用及其驱动因素的驱动因素及 对结果的影响，并确定转向提供者和患者行为的潜在干预措施以改进 结果和降低成本（财务和辐射风险）。一旦监视测试的重要驱动力 已确定，该信息可用于至少三种方式来提高护理价值。首先，患者会 在成本和辐射暴露方面更好地了解潜在风险 监视测试。第二，由于美国每年在成像和其他测试上花费超过40亿美元 癌症护理，即使昂贵的不必要的监视测试的利用也很小减少 代表大量的财务节省，而无需增加死亡率。第三，如果提供者了解效果，或者 缺乏效果，现代监视测试方法对包括金融伯宁在内的患者结局的方法 辐射风险和死亡率，他们遵守准则的意愿以及患者的结果可以改善。 在这个项目中，我们将在全国范围内估算监视测试使用的变化，并将 生成有关提供商特征和实践模式之间关联和实践模式和实践模式之间关联的第一个数据 监视测试率（目标1和3）。我们将提供有关监视对患者影响的第一个数据 和社会成果，首次估计完成的测试成本和辐射暴露的成本和辐射暴露 与准则不一致（AIM 2和4）。最后，我们将创建第一个定性数据，以使我们能够 生成有关为什么监视发生的假设，可用于制定干预措施以减少 可以在将来的随机试验中测试的不必要测试。