Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent

Authors

  • Ramzi G. Salloum PhD,

    Corresponding author
    1. Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    2. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
    • Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102F McGavran-Greenberg, 135 Dauer Dr, Chapel Hill, NC 27599-7411
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    • Fax: (919) 843-6362

  • Mark C. Hornbrook PhD,

    1. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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  • Paul A. Fishman PhD,

    1. Group Health Research Institute, Group Health Cooperative, Seattle, Washington
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  • Debra P. Ritzwoller PhD,

    1. Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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  • Maureen C. O'Keeffe Rossetti MS,

    1. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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  • Jennifer Elston Lafata PhD

    1. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
    2. Social and Behavioral Health and Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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Abstract

BACKGROUND:

Evidence-based guidelines recommend routine surveillance, including office visits and testing, to detect new and recurrent disease among survivors of breast and colorectal cancer. The extent to which surveillance practice is consistent with guideline recommendations or may vary by age is not known.

METHODS:

Cohorts of adult patients diagnosed with breast (n = 6205) and colorectal (n = 2297) cancer between 2000 and 2008 and treated with curative intent in 4 geographically diverse managed care environments were identified via tumor registries. Kaplan-Meier estimates were used to describe time to initial and subsequent receipt of surveillance services. Cox proportional hazards models evaluated the relation between patient characteristics and receipt of metastatic screening.

RESULTS:

Within 18 months of treatment, 87.2% of breast cancer survivors received recommended mammograms, with significantly higher rates noted for patients aged 50 years to 65 years. Among survivors of colorectal cancer, only 55.0% received recommended colon examinations, with significantly lower rates for those aged ≥ 75 years. The majority of breast (64.7%) and colorectal (73.3%) cancer survivors received nonrecommended metastatic disease testing. In patients with breast cancer, factors associated with metastatic disease testing include white race (hazards ratio [HR], 1.13), comorbidities (HR, 1.17), and younger age (HR, 1.13; 1.15; 1.13 for age groups: <50, 50–64, and 65–74 respectively). In those with colorectal cancer, these factors included younger age (HR, 1.31; 1.25 for age groups: <50 and 50–64 respectively) and comorbidities (HR, 1.10).

CONCLUSIONS:

Among an insured population, wide variation regarding the use of surveillance care was found by age and relative to guideline recommendations. Breast cancer survivors were found to have high rates of both guideline-recommended recurrence testing and non–guideline-recommended metastatic testing. Only approximately 50% of colorectal cancer survivors received recommended tests but greater than 67% received metastatic testing. Cancer 2012. © 2012 American Cancer Society.

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