Population-based longitudinal study of follow-up care for breast cancer survivors

Abstract

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.

Figure 1.

Adherence to guidelines by follow-up year, defined as three or four visits per year in years 2 and 3; two visits per year in years 4 and 5; one mammogram per year. L, less than recommended; R, recommended; G, greater than recommended. (*) P < .05.

Figure A1.

Adherence to guidelines by patient age, defined as six to eight visits over years 2 and 3, three to four visits over years 4 and 5, three to five mammograms over 4 years. L, less than recommended; R, recommended; G, greater than recommended. (*) P < .05.