Quality of Follow-up Care for Breast Cancer Survivors

描述(由调查人员提供)：1997年，美国估计有200万乳腺癌幸存者活着。从历史上看，许多临床医生认为应定期进行复发性疾病的监测、放射检查和实验室检测。然而，最近的随机试验和专业协会的指导方针明确表示，虽然应该每年进行乳房X光检查，但其他检查应该只评估症状或体征。 有证据表明，对乳腺癌幸存者的监测护理质量存在问题：使用乳房X光检查不足，过度使用非常规实验室和放射检查。该项目将使用与医疗保险索赔相关的基于人群的监测、流行病学和最终结果(SEER)肿瘤登记数据来评估老年乳腺癌幸存者护理质量的决定因素。 这项研究的具体目的是：1.描述老年乳腺癌幸存者和年龄匹配的对照组受试者的监测测试模式(乳房X光检查、胸部X光检查、骨扫描、CT扫描、肝功能测试)。2.评估1994年公布的两项随机试验对监测测试率的影响，这两项试验表明密集监测测试缺乏效力。3.评估卫生保健提供因素对监测测试率的影响，例如大多数保健提供者(为患者提供大部分诊疗服务的医生)和共同管理的保健(由初级保健提供者和肿瘤学专家管理)。4.评估提供者特征(例如年龄、性别、专业)和患者特征(例如种族、社会经济状况、初步治疗)对监测测试率的影响。这一结果将产生有关乳腺癌监测护理的重要公共政策信息。

DESCRIPTION (provided by investigator): In 1997, there were an estimated two million breast cancer survivors alive in the United States. Historically, many clinicians have believed that surveillance radiographic and laboratory testing for recurrent disease should be carried out routinely. However, more recent randomized trials and professional society guidelines have made it clear that while mammograms should be done annually, other tests should only be done to evaluate symptoms or signs. Evidence exists of problems with the quality of surveillance care for breast cancer survivors: under use of mammography, and over use of non-routine laboratory and radiographic tests. This project will use population-based Surveillance, Epidemiology, and End Results (SEER) Tumor Registry data linked to Medicare claims to evaluate determinants of the quality of care of older breast cancer survivors. The specific aims of this study are: 1. Describe patterns of surveillance testing (mammograms, chest radiographs, bone scans, CT scans, liver function tests) among older breast cancer survivors, and among age-matched control subjects. 2. Assess the effects on surveillance testing rates of the publication of two randomized trials in 1994 showing the lack of effectiveness of intensive surveillance testing. 3. Assess the effects on surveillance testing rates of health care delivery factors, such as the presence of a majority of care provider (a physician providing the majority of the patient's office visits), and co-managed care (management by both a primary care provider and an oncology specialist). 4. Assess the effect on surveillance testing rates of provider characteristics (e.g. age, gender, specialty) and of patient characteristics (e.g. race, socioeconomic status, initial therapy). The results will yield important public policy information regarding breast cancer surveillance care.