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Edmonds MC, Kim SJ, Wells M, Dahman B, Sheppard VB. A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors. Clin Breast Cancer 2022; 22:801-811. [PMID: 36137937 DOI: 10.1016/j.clbc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. METHODS This is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). RESULTS 76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. CONCLUSION Women may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors' surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Matthew Wells
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
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Advani P, Advani S, Nayak P, VonVille HM, Diamond P, Burnett J, Brewster AM, Vernon SW. Racial/ethnic disparities in use of surveillance mammogram among breast cancer survivors: a systematic review. J Cancer Surviv 2021; 16:514-530. [PMID: 33982233 DOI: 10.1007/s11764-021-01046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increasing number of breast cancer survivors in the USA have led to greater focus on the long-term health outcomes and surveillance care among these women. However limited evidence exists of use of surveillance mammography among breast cancer survivors and how it varies across racial/ethnic groups. METHODS We conducted a systematic review of the literature to explore disparities in use of surveillance mammogram among women breast cancer survivors by searching for relevant studies published between 2000 and 2020 from Medline (Ovid), PubMed (National Library of Medicine), and PsycINFO (Ovid) bibliographic databases. Two authors independently screened titles, abstracts, and full texts of all articles that reported surveillance mammography use across racial/ethnic groups. Data on study design, screening eligibility, sample size, operational definition, and/or measure of the use of a surveillance mammogram among breast cancer survivors and the association between race/ethnicity and use of a surveillance mammogram were summarized in the evidence tables. RESULTS We identified 1544 records from the three databases, and 30 studies examined the use of surveillance mammograms among breast cancer survivors across race/ethnic groups. Of these, 21 provided adjusted estimates of racial/ethnic disparities in use of surveillance mammograms, and 15 of these reported statistically significant disparities. In summary, most studies reported that non-white women (mainly Blacks and Hispanics) were less likely to receive a timely surveillance mammogram compared to White. CONCLUSION This study extends the evidence of racial/ethnic disparities beyond completion of initial treatment by finding similar disparities in receipt of surveillance mammograms among breast cancer survivors. IMPLICATION FOR CANCER SURVIVORS Our findings identify a need to improve efforts to increase post-treatment use of surveillance mammography among racial/ethnic minority women to reduce these gaps and improve overall clinical and quality of life outcomes.
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Affiliation(s)
- Pragati Advani
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E-528, MSC 9778, Bethesda, MD, USA.
| | - Shailesh Advani
- Social Epidemiology Research Unit, Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pratibha Nayak
- Population Health Science, Battelle Memorial Institute, Atlanta, GA, USA
| | - Helena M VonVille
- Library, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Pamela Diamond
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jason Burnett
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Jansana A, Del Cura I, Prados-Torres A, Sanz Cuesta T, Poblador-Plou B, Gimeno Miguel A, Lanzuela M, Ibañez B, Tamayo I, Moreno-Iribas C, Padilla-Ruiz M, Redondo M, Comas M, Domingo L, Díaz-Holgado A, Salamanca FJ, Castells X, Sala M. Use of real-world data to study health services utilisation and comorbidities in long-term breast cancer survivors (the SURBCAN study): study protocol for a longitudinal population-based cohort study. BMJ Open 2020; 10:e040253. [PMID: 32912957 PMCID: PMC7482495 DOI: 10.1136/bmjopen-2020-040253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Breast cancer has become a chronic disease due to survival improvement and the need to monitor the side effects of treatment and the disease itself. The aim of the SURBCAN study is to describe comorbidity, healthcare services use and adherence to preventive recommendations in long-term breast cancer survivors and to compare them with those in women without this diagnosis in order to improve and adapt the care response to this group of survivors. METHODS AND ANALYSIS Population-based retrospective cohort study using real-world data from cancer registries and linked electronic medical records in five Spanish regions. Long-term breast cancer survivors diagnosed between 2000 and 2006 will be identified and matched by age and administrative health area with women without this diagnosis. Sociodemographic and clinical variables including comorbidities and variables on the use of health services between 2012 and 2016 will be obtained from databases in primary and hospital care. Health services use will be assessed through the annual number of visits to primary care professionals and to specialists and through annual imaging and laboratory tests. Factors associated with healthcare utilisation and comorbidities will be analysed using multilevel logistic regression models. Recruitment started in December 2018. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Parc de Salut Mar. The results of the study will be published in a peer-reviewed journal and will be presented at national and international scientific conferences and at patient associations. TRIAL REGISTRATION NUMBER This protocol is registered in Clinical Trials.gov (identifier: NCT03846999).
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Isabel Del Cura
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Primary Care Research Unit, Madrid Health Service, Madrid, Madrid, Spain
| | - Alexandra Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- EpiChron Research Group on Chronic Diseases, IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, Zaragoza, Spain
| | - Teresa Sanz Cuesta
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Primary Care Research Unit, Comunidad de Madrid Servicio Madrileno de Salud, Madrid, Spain
| | - Beatriz Poblador-Plou
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- EpiChron Research Group on Chronic Diseases, IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, Zaragoza, Spain
| | - A Gimeno Miguel
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- EpiChron Research Group on Chronic Diseases, IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, Zaragoza, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Zaragoza, Aragón, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Unit of Methodology, Navarrabiomed-Fundación Miguel Servet, Pamplona, Navarra, Spain
| | - Ibai Tamayo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Unit of Methodology, Navarrabiomed-Fundación Miguel Servet, Pamplona, Navarra, Spain
| | - Conchi Moreno-Iribas
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Unit of Methodology, Navarrabiomed-Fundación Miguel Servet, Pamplona, Navarra, Spain
| | - María Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Research Unit - IBIMA, Hospital Costa del Sol, Marbella, Andalucía, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Research Unit - IBIMA, Hospital Costa del Sol, Marbella, Andalucía, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Antonio Díaz-Holgado
- Information System Unit, Directorate for Public Health, Health Service of Madrid, Madrid, Spain
| | | | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Madrid, Spain
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Reed SC, Bell JF, Miglioretti DL, Nekhlyudov L, Fairman N, Joseph JG. Relationships Between Fear of Cancer Recurrence and Lifestyle Factors Among Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:669-677. [PMID: 30879181 DOI: 10.1007/s13187-019-01509-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examine the relationships between fear of cancer recurrence (FCR), physical activity, smoking status, and engagement in healthier habits in a US population-based sample of post-treatment cancer survivors. We used data from the 2011 Medical Expenditure Panel Survey (MEPS) Experience with Cancer Survivorship Supplement. Multivariable logistic regression was used to test the relationship of FCR to physical activity, smoking status, and engagement in healthier habits. In all analyses, MEPS survey weights were applied to account for the survey design. Compared with those reporting no FCR, survivors reporting high FCR had significantly lower odds of reporting that they were not currently smokers (odds ratio [OR] = 0.46; 95% CI 0.24, 0.91) and those with any level of FCR had significantly higher odds of reporting healthier habits since diagnosis relative to those with no FCR (low FCR OR = 1.97; 95% CI 1.36, 2.85; high FCR OR = 2.40; 95% CI 1.33, 4.32). FCR was not associated with the odds of reporting physical activity. Findings from this large population-based survey suggest that some of survivors' lifestyle factors may be related to their level of FCR. Understanding the effects of FCR on lifestyle factors may help survivors, survivorship care providers, and policy makers better understand important differences among cancer survivors and personalize interventions in clinical care.
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Affiliation(s)
- Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Davis, Betty Irene Moore Hall, 2570 48th Street, Sacramento, CA, 95817, USA.
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Betty Irene Moore Hall, 2570 48th Street, Sacramento, CA, 95817, USA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Medical Science 1C, Suite 145, Davis, CA, 95616, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, 800 Huntington Avenue, Boston, MA, 02115, USA
| | - Nathan Fairman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2230 Stockton Blvd., Sacramento, CA, 95817, USA
- Comprehensive Cancer Center, University of California, Davis, 2279 45th Street, Sacramento, CA, 95817, USA
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Betty Irene Moore Hall, 2570 48th Street, Sacramento, CA, 95817, USA
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5
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Lo-Fo-Wong DN, de Haes HC, Aaronson NK, van Abbema DL, Admiraal JM, den Boer MD, van Hezewijk M, Immink M, Kaptein AA, Menke-Pluijmers MB, Russell NS, Schriek M, Sijtsema S, van Tienhoven G, Sprangers MA. Health care use and remaining needs for support among women with breast cancer in the first 15 months after diagnosis: the role of the GP. Fam Pract 2020; 37:103-109. [PMID: 31504455 PMCID: PMC7031058 DOI: 10.1093/fampra/cmz043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The number of women with breast cancer in general practice is rising. To address their needs and wishes for a referral, GPs might benefit from more insight into women's health care practices and need for additional support. OBJECTIVE To examine the prevalence of health care use and remaining needs among women with breast cancer in the first 15 months after diagnosis. METHODS In this multicentre, prospective, observational study women with breast cancer completed a questionnaire at 6 and 15 months post-diagnosis. Medical data were retrieved through chart reviews. The prevalence of types of health care used and remaining needs related to medical, psychosocial, paramedical and supplementary service care (such as home care), was examined with descriptive analyses. RESULTS Seven hundred forty-six women completed both questionnaires. At both assessments patients reported that they had most frequent contact with medical and paramedical providers, independent of types of treatment received. Three to fifteen percent of the patients expressed a need for more support. Prominent needs included a wish for more frequent contact with a physiotherapist, a clinical geneticist and a psychologist. Patients also wanted more help for chores around the house, particularly in the early post-treatment phase. CONCLUSION A small but relevant percentage of women with breast cancer report having unmet needs. GPs may need to be particularly watchful of their need for more support from specific providers. Future research into the necessity of structural needs assessment among cancer patients in general practice is warranted.
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Affiliation(s)
| | - Hanneke C de Haes
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam
| | - Neil K Aaronson
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Doris L van Abbema
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - Jolien M Admiraal
- University Medical Center Groningen, University of Groningen, Groningen
| | | | | | | | | | | | - Nicola S Russell
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | | | | | | | - Mirjam A Sprangers
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam
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Franc BL, Thombley R, Luo Y, John Boscardin W, Rugo HS, Seidenwurm D, Dudley RA. Using diagnosis codes in claims data to identify cohorts of breast cancer patients following initial treatment. Breast J 2020; 26:1472-1474. [PMID: 31960541 DOI: 10.1111/tbj.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin L Franc
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Thombley
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | - Yanting Luo
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- Department of Medicine, Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Hope S Rugo
- Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - R Adams Dudley
- Philip R. Lee Institute for Health Policy Studies, Center for Healthcare Value, University of California, San Francisco, CA, USA
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Jang MK, Hershberger PE, Kim S, Collins EG, Quinn LT, Park CG, Ferrans CE. Factors Influencing Surveillance Mammography Adherence Among Breast Cancer Survivors. Oncol Nurs Forum 2019; 46:701-714. [PMID: 31626613 DOI: 10.1188/19.onf.701-714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Many breast cancer survivors fail to engage in surveillance mammography to detect new and recurrent cancers. This review identifies factors promoting or inhibiting breast cancer survivors' participation in recommended surveillance mammography. LITERATURE SEARCH This integrative review included all English-language studies published from 2000 to 2017, identified in CINAHL®, PsycINFO®, Embase®, and MEDLINE® via PubMed®. DATA EVALUATION 23 studies met the inclusion criteria and were analyzed and synthesized. SYNTHESIS 19 factors influencing mammography adherence were identified and organized into a conceptual model with two major categories. IMPLICATIONS FOR RESEARCH The new model of predictors of mammography adherence can provide guidance for identifying individuals at greatest risk for nonadherence, as well as development of new interventions to address barriers to regular mammography screening, to promote early detection of new and recurrent cancers and improved survival rates.
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Tevaarwerk AJ, Hocking WG, Buhr KA, Gribble M, Seaborne LA, Wisinski KB, Burkard ME, Yen T, Wiegmann DA, Sesto ME. A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment. Cancer 2019; 125:1000-1007. [PMID: 30690714 DOI: 10.1002/cncr.31875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed. METHODS Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks. RESULTS In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time. CONCLUSIONS This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.
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Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | | | - Kevin A Buhr
- Department of Biostatistics and Medical Informatics, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Mindy Gribble
- Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Lori A Seaborne
- Department of Surgery, The University of Wisconsin-Madison, Madison, Wisconsin
| | - Kari B Wisinski
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mark E Burkard
- Division of Hematology/Oncology, Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin.,The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin
| | - Thomas Yen
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Douglas A Wiegmann
- The University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Mary E Sesto
- The University of Wisconsin-Madison Carbone Cancer Center, Madison, Wisconsin.,Department of Medicine, The University of Wisconsin-Madison, Madison, Wisconsin
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Puigpinós-Riera R, Castillo Gómez A, Romero Morales A, Aller M, Castells X, Sala M. [Social and clinical determinants of the use of health services in women with breast cancer (Cohort DAMA)]. GACETA SANITARIA 2018; 33:434-441. [PMID: 30031657 DOI: 10.1016/j.gaceta.2018.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project. METHOD Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals. RESULTS The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions. CONCLUSIONS The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this.
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Affiliation(s)
- Rosa Puigpinós-Riera
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Biomèdica Sant Pau, Barcelona, España.
| | - Adán Castillo Gómez
- Servei d'Epidemiologia i Avaluació, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, España
| | - Anabel Romero Morales
- Servei d'Epidemiologia i Avaluació, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, España; Red de Investigación de Servicios de Salud (REDISSEC), España
| | - Marta Aller
- Servei d'Epidemiologia i Avaluació, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, España; Red de Investigación de Servicios de Salud (REDISSEC), España
| | - Xavier Castells
- Servei d'Epidemiologia i Avaluació, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, España; Red de Investigación de Servicios de Salud (REDISSEC), España; Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva i Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - María Sala
- Servei d'Epidemiologia i Avaluació, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, España; Red de Investigación de Servicios de Salud (REDISSEC), España; Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva i Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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10
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Bošković L, Gašparić M, Petrić Miše B, Petković M, Gugić D, Ban M, Jazvić M, Dabelić N, Belac Lovasić I, Vrdoljak E. Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Bošković
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | | | - B. Petrić Miše
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | - M. Petković
- Clinic for Oncology and Radiotherapy; University Hospital Rijeka; Rijeka Croatia
| | - D. Gugić
- University Hospital Osijek; Osijek Croatia
| | - M. Ban
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | - M. Jazvić
- Department of Oncology and Nuclear Medicine; University Hospital Sestre Milosrdnice; Zagreb Croatia
| | - N. Dabelić
- Department of Oncology and Nuclear Medicine; University Hospital Sestre Milosrdnice; Zagreb Croatia
| | - I. Belac Lovasić
- Clinic for Oncology and Radiotherapy; University Hospital Rijeka; Rijeka Croatia
| | - E. Vrdoljak
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
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Tevaarwerk AJ, Hocking WG, Zeal JL, Gribble M, Seaborne L, Buhr KA, Wisinski KB, Burkard ME, Wiegmann DA, Sesto ME. Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers. J Oncol Pract 2017; 13:e486-e495. [PMID: 28221896 DOI: 10.1200/jop.2016.018648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. METHODS As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. RESULTS One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. CONCLUSION A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.
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Affiliation(s)
- Amye J Tevaarwerk
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - William G Hocking
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Jamie L Zeal
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mindy Gribble
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Lori Seaborne
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Kevin A Buhr
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Kari B Wisinski
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mark E Burkard
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Douglas A Wiegmann
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
| | - Mary E Sesto
- University of Wisconsin; Carbone Cancer Center, Madison; and Marshfield Clinic, Marshfield, WI
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12
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Ruddy KJ, Guo H, Baker EL, Goldstein MJ, Mullaney EE, Shulman LN, Partridge AH. Randomized phase 2 trial of a coordinated breast cancer follow-up care program. Cancer 2016; 122:3546-3554. [DOI: 10.1002/cncr.30206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/06/2016] [Accepted: 06/10/2016] [Indexed: 01/11/2023]
Affiliation(s)
| | - Hao Guo
- Department of biostatistics and computational biology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Emily L. Baker
- Division of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | | | - Erin E. Mullaney
- Division of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Lawrence N. Shulman
- Division of Hematology/Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ann H. Partridge
- Division of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Department of Medicine; Brigham and Women's Hospital; Boston Massachusetts
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13
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Feiten S, Dünnebacke J, Friesenhahn V, Heymanns J, Köppler H, Meister R, Thomalla J, van Roye C, Wey D, Weide R. Follow-up Reality for Breast Cancer Patients - Standardised Survey of Patients and Physicians and Analysis of Treatment Data. Geburtshilfe Frauenheilkd 2016; 76:557-563. [PMID: 27239065 DOI: 10.1055/s-0042-106210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Introduction: Currently, about 360 000 breast cancer patients who could, after completion of their primary therapy, take advantage of follow-up options are living in Germany. Up to now very little is known about the extent to which the available options are used and as to how the follow-up reality is experienced and evaluated. Thus, an explorative examination among the patients and their physicians was undertaken. Patients and Methods: All patients who underwent surgery in a certified breast centre between 2007 and 2013 received a standardised questionnaire; at the same time the physicians responsible for the follow-up were invited to answer a standardised questionnaire. Results: 920 patients (response rate: 61 %) with a median age of 65 years (32-95) could be analysed. 99 % of the participants stated that they regularly attended follow-ups. The personal contact with the physician (mean value: 4.4) and the reassurance that the cancer disease had not recurred (mean value: 4.5) were described on a scale of 0 to 5 to be two of the most important factors of the follow-up. Deficits were expressed with regard to psychosocial care (70 %) and the perception and treatment of physical complaints (55 %). In addition, 105 physicians returned completed questionnaires (response rate: 12 %). For asymptomatic patients the physicians performed the following examinations most frequently: anamnesis (92 %), physical examination (87 %) as well as laboratory tests (63 %) and tumour marker determinations (40 %). Conclusion: On the whole it became clear that the vast majority of the patients took advantage of the follow-up options. From the patient's perspective the importance of the follow-up lies in contact to the physician and the comforting assurance that the breast cancer has not relapsed. Deficits are seen in the psychosocial care and the perception and treatment of physical impairments. Not recommended examinations were employed by a significant proportion of the surveyed physicians.
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Affiliation(s)
- S Feiten
- Institut für Versorgungsforschung in der Onkologie, Koblenz
| | - J Dünnebacke
- Brustzentrum im Marienhof, Katholisches Klinikum Koblenz-Montabaur, Koblenz
| | - V Friesenhahn
- Institut für Versorgungsforschung in der Onkologie, Koblenz
| | - J Heymanns
- Praxisklinik für Hämatologie und Onkologie, Koblenz
| | - H Köppler
- Praxisklinik für Hämatologie und Onkologie, Koblenz
| | - R Meister
- Institut für Versorgungsforschung in der Onkologie, Koblenz
| | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie, Koblenz
| | - C van Roye
- Praxisklinik für Hämatologie und Onkologie, Koblenz
| | - D Wey
- Brustzentrum im Marienhof, Katholisches Klinikum Koblenz-Montabaur, Koblenz
| | - R Weide
- Praxisklinik für Hämatologie und Onkologie, Koblenz
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14
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Ganz PA, Hahn EE, Petersen L, Melisko ME, Pierce JP, Von Friederichs-Fitzwater M, Lane KT, Hiatt RA. Quality of Posttreatment Care Among Breast Cancer Survivors in the University of California Athena Breast Health Network (Athena). Clin Breast Cancer 2016; 16:356-363. [PMID: 27397694 DOI: 10.1016/j.clbc.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Multiple oncology providers are involved in the initial breast cancer treatment. To better understand the patterns and quality of posttreatment breast cancer care, we surveyed patients who had been treated at each of the 5 University of California (UC) cancer centers. PATIENTS AND METHODS We identified breast cancer patients diagnosed in 2008-2009 from hospital tumor registries; invitations for the mailed survey on posttreatment care were sent between September 2011 and November 2012. The survey requested information on the number and type of provider visits, discussion of key topics, use of treatment summaries, and survivorship care plans (SCP). RESULTS A total of 329 patients completed the survey. The mean age of respondents was 60.5 years, and they were 3.2 years since diagnosis (range, 1.6-4.8 years). A total of 82% had continued posttreatment care at a UC facility, and they reported high numbers of clinical follow-up visits, with an average of > 2 providers (range, 1-5). Surgery-only patients reported an average of 4 to 5 office visits a year; patients who received surgery, radiation, and chemotherapy reported 5 to 6 office visits a year. Overall, 45% of women reported receiving a treatment summary; receipt of a SCP was reported by 59%, occurring significantly more often among those in follow-up at a UC (P = .004). CONCLUSION Patients reported visits to multiple providers during their follow-up care, in excess of what is recommended by current guidelines. This was in spite of many women reporting that they had received a SCP.
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Affiliation(s)
- Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA.
| | - Erin E Hahn
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - John P Pierce
- Moores Cancer Center, University of California, San Diego, CA
| | | | - Karen T Lane
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA
| | - Robert A Hiatt
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
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15
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Rabin BA, Ellis JL, Steiner JF, Nekhlyudov L, Feuer EJ, Hankey BF, Cynkin L, Bayliss E. Health-care utilization by prognosis profile in a managed care setting: using the Surveillance, Epidemiology and End Results Cancer Survival Calculator SEER*CSC. J Natl Cancer Inst Monogr 2015; 2014:275-81. [PMID: 25417241 DOI: 10.1093/jncimonographs/lgu023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Accurate estimation of the probability of dying of cancer versus other causes is needed to inform goals of care for cancer patients. Further, prognosis may also influence health-care utilization. This paper describes health service utilization patterns of subgroups of prostate cancer and colorectal cancer (CRC) patients with different relative probabilities of dying of their cancer or other conditions. METHODS A retrospective cohort of cancer patients from Kaiser Permanente Colorado were divided into three groups using the predicted probabilities of dying of cancer and other causes calculated by the nomograms in the National Cancer Institute Surveillance, Epidemiology and End Results Cancer Survival Calculator. Demographic, disease-related characteristics, and health service utilization patterns were described across subgroups. RESULTS The cohort consisted of 2092 patients (1102 prostate cancer and 990 CRC). A new diagnosis of cancer increased utilization of cancer-related services with rates as high as 9.1/1000 person-days for prostate cancer and 36.2/1000 person-days for CRC. Little change was observed in the number of primary and other specialty care visits from prediagnosis to 1 and 2 years postdiagnosis. CONCLUSIONS We found that although a new diagnosis of cancer increased utilization of cancer-related services for an extended time period, the timing of cancer diagnosis did not appear to affect other types of utilization. Future research should assess the reason for the lack of impact of cancer and unrelated comorbid conditions on utilization and whether desired outcomes of care were achieved.
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Affiliation(s)
- Borsika A Rabin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC).
| | - Jennifer L Ellis
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - John F Steiner
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Larissa Nekhlyudov
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Eric J Feuer
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Benjamin F Hankey
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Laurie Cynkin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Elizabeth Bayliss
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
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16
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Lo-Fo-Wong DNN, Sitnikova K, Sprangers MAG, de Haes HCJM. Predictors of Health Care Use of Women with Breast Cancer: A Systematic Review. Breast J 2015; 21:508-13. [DOI: 10.1111/tbj.12447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kate Sitnikova
- Department of Medical Psychology; Academic Medical Center; Amsterdam The Netherlands
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17
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Survivorship care plans and time since diagnosis: factors that contribute to who breast cancer survivors see for the majority of their care. Support Care Cancer 2015; 23:2669-76. [DOI: 10.1007/s00520-015-2629-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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18
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The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015; 30:251-77. [DOI: 10.1007/s10654-014-9984-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
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19
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Health services utilisation in breast cancer survivors in Taiwan. Sci Rep 2014; 4:7466. [PMID: 25502076 PMCID: PMC4264011 DOI: 10.1038/srep07466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 01/22/2023] Open
Abstract
Surveillance guidelines for breast cancer survivors recommend regular history and physical and mammography, and against routine imaging for detecting distant metastasis. Stage 0, I, II breast cancer cases treated at a major cancer center were identified from the Taiwan Cancer Registry. We used multivariable negative binomial and logistic regression analyses on institutional claims data to examine factors contributing to utilisation patterns of surveillance visits and tests in disease-free survivors. The mean number of surveillance visits during months 13 to 60 after cancer treatment initiation was 18.5 (SD 8.2) among the 2,090 breast cancer survivors followed for at least five years. After adjusting for patient and disease factors, the number of visits was the highest among patients mainly followed by medical oncologists compared to surgeons and radiation oncologists. Patient cohorts treated in more recent years had lower number of visits associated with care coordination effort, the adjusted mean being 19.2 visits for the 2002 cohort, and 16.3 visits for the 2008 cohort (p < 0.0001). Although imaging tests were highly utilised, there was a significant decrease in tumor marker testing from the 2002 to the 2008 treatment cohort (adjusted rate 99.4% to 35.1% respectively, p < 0.0001) in association with an institutional guideline change.
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20
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Matro JM, Goldstein LJ. How do I follow patients with early breast cancer after completing adjuvant therapy. Curr Treat Options Oncol 2014; 15:63-78. [PMID: 24346688 DOI: 10.1007/s11864-013-0265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT With improvements in the detection and treatment of breast cancer, more women are surviving after diagnosis. Patients who complete adjuvant therapy require ongoing follow-up to manage toxicities, to detect recurrences early, and to provide ongoing physical and psychosocial support. Routine surveillance should be implemented, with attention to educating patients about symptoms of recurrence, such as weight loss, cough, and bone pain. An intensive surveillance strategy with the routine use of laboratory and radiographic studies does not improve outcomes and raises the cost of follow-up. Patients should have annual mammograms in conjunction with physical exam and history at appropriate intervals that increase the farther out patients are from treatment. Attention also should be focused on other routine health maintenance and cancer screening, such as colonoscopy, gynecologic examinations, and bone health/DEXA scans. In the early posttreatment period, medical oncologists are best equipped to follow these patients. However, as women live longer after a breast cancer diagnosis and treatment, transitioning care to a primary care physician or nurse practitioner is appropriate, provided these practitioners are educated about late treatment effects and managing side effects of treatment, which may continue as long as a decade. A multidisciplinary follow-up strategy with excellent communication between providers can ensure safe, convenient, and quality care to the growing population of breast cancer survivors. As the treatment of breast cancer evolves into personalized strategies based on the biologic characteristics of individual tumors, future studies will be needed to determine if a single surveillance strategy is sufficient or if individualized surveillance based on risk can improve outcomes and costs of long-term follow-up care.
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Affiliation(s)
- Jennifer M Matro
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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21
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Corner J. Addressing the needs of cancer survivors: issues and challenges. Expert Rev Pharmacoecon Outcomes Res 2014; 8:443-51. [DOI: 10.1586/14737167.8.5.443] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Knobf MT. Being prepared: essential to self-care and quality of life for the person with cancer. Clin J Oncol Nurs 2013; 17:255-61. [PMID: 23715703 DOI: 10.1188/13.cjon.255-261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Being adequately prepared for an experience such as cancer empowers patients, lowers distress, improves coping, supports self-management, promotes recovery, and improves quality of life. However, patients with cancer report unmet informational and support needs across the cancer trajectory. The purpose of this article is to describe the relationship of information preparation and patient outcomes, identify information and support needs across the cancer trajectory, and describe the role of oncology nurses in the delivery of high-quality patient-centered cancer care. The middle range theory of "Carrying On" was used to identify information and support needs during different phases of the cancer trajectory from treatment to survivorship. The authors concluded that nurses should engage the patient in a relational exchange of information; provide concrete, understandable information across specific times in the cancer experience; and use creative approaches to minimize barriers in meeting patient needs to achieve high-quality patient-centered cancer care.
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Affiliation(s)
- M Tish Knobf
- School of Nursing, Yale University, New Haven, CT, USA.
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23
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Enewold L, McGlynn KA, Zahm SH, Jatoi I, Anderson WF, Gill AA, Shriver COLCD, Zhu K. Surveillance mammography among female Department of Defense beneficiaries: a study by race and ethnicity. Cancer 2013; 119:3531-8. [PMID: 23913448 PMCID: PMC3787997 DOI: 10.1002/cncr.28242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/11/2013] [Accepted: 05/10/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Annual surveillance mammography is recommended after a diagnosis of breast cancer. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to an individual's access to health care. The Military Health System of the Department of Defense provides beneficiaries with equal access health care and thus offers an excellent opportunity to assess whether racial differences in surveillance mammography persist when access to care is equal. METHODS Among female beneficiaries with a history of breast cancer, logistic regression was used to assess racial/ethnic variations in the use of surveillance mammography during 3 periods of 12 months each, beginning 1 year after diagnosis adjusting for demographic, tumor, and health characteristics. RESULTS The rate of overall surveillance mammography decreased from 70% during the first year to 59% during the third year (P < .01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared with non-Hispanic white women, after adjusting for covariates, the difference was found to be significant only during the first year among black women (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.10-1.95) and the second year among Asian/Pacific Islander (OR, 2.29; 95%CI, 1.52-3.44) and Hispanic (OR, 1.92; 95%CI, 1.17-3.18) women. When stratified by age at diagnosis and type of breast cancer surgery performed, significant racial differences tended to be observed among younger women (aged < 50 years) and only among women who had undergone mastectomies. CONCLUSIONS Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the Military Health System. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to health care.
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Affiliation(s)
- Lindsey Enewold
- Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 11300 Rockville Pike Suite 1215, Rockville, MD 20852
- National Cancer Institute, NIH, 6130 Executive Boulevard, Bethesda, MD 20892
| | | | - Shelia H. Zahm
- National Cancer Institute, NIH, 6130 Executive Boulevard, Bethesda, MD 20892
| | - Ismail Jatoi
- Department of Surgery, UT Health Science Center at San Antonio, San Antonio, TX, USA
| | - William F. Anderson
- National Cancer Institute, NIH, 6130 Executive Boulevard, Bethesda, MD 20892
| | - Abegail A. Gill
- Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 11300 Rockville Pike Suite 1215, Rockville, MD 20852
| | - COL Craig D. Shriver
- John P. Murtha Cancer Center and Breast Center and General Surgery Services, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kangmin Zhu
- Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 11300 Rockville Pike Suite 1215, Rockville, MD 20852
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
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24
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Hahn EE, Hays RD, Kahn KL, Litwin MS, Ganz PA. Use of imaging and biomarker tests for posttreatment care of early-stage breast cancer survivors. Cancer 2013; 119:4316-24. [PMID: 24105101 DOI: 10.1002/cncr.28363] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) recently released a "Top Five" list of opportunities to improve the quality of cancer care. Item 4 on the list advises against using advanced imaging and biomarkers for surveillance in patients with breast cancer who are treated with curative intent. This study examined concordance with ASCO follow-up care guidelines for breast cancer survivors treated at an academic medical center. METHODS Claims data and medical records were reviewed and abstracted for early stage breast cancer survivors starting 1 year post diagnosis. A trained abstractor classified imaging tests as diagnostic or surveillance. Proportions and frequencies were generated for receipt of services. Multilevel logistic regression was used to estimate factors associated with receiving recommended and nonrecommended services and biomarker tests. RESULTS Records were available for 258 patients. Mean age at diagnosis was 58 years (standard deviation of 13 years), mean time since diagnosis was 6 years (standard deviation of 2 years), and 71% were stage 0/1. Only 47% of the sample received a mammogram within 1 year of diagnosis, and 55% of the sample received at least 1 nonrecommended imaging service for surveillance purposes. Seventy-seven percent of the sample received at least 1 nonrecommended biomarker test. Regression results indicate that main treating physician, advanced disease stage, younger age at diagnosis, and greater number of years since diagnosis were associated with receiving nonrecommended services for surveillance. CONCLUSIONS Use of nonrecommended services for surveillance occurs frequently among early-stage breast cancer survivors. There are opportunities to increase use of guideline concordant posttreatment care for breast cancer survivors.
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Affiliation(s)
- Erin E Hahn
- University of California Los Angeles (UCLA) Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, California; Division of Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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25
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Spoelstra SL, Given BA, Schutte DL, Sikorskii A, You M, Given CW. Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer. Oncol Nurs Forum 2013; 40:E69-78. [PMID: 23448747 DOI: 10.1188/13.onf.e69-e78] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine whether a history of cancer increased the likelihood of a fall in community-dwelling older adults, and if cancer type, stage, or time since diagnosis increased falls. DESIGN A longitudinal, retrospective, cohort study. SETTING A home- and community-based waiver program in Michigan. SAMPLE 862 older adults aged 65 years or older with cancer compared to 8,617 older adults without cancer using data from the Minimum Data Set-Home Care and Michigan cancer registry. METHODS Reports of falls were examined for 90-180 days. Generalized estimating equations were used to compare differences between the groups. MAIN RESEARCH VARIABLES Cancer, falls, patient characteristics, comorbidities, medications, pain, weight loss, vision, memory recall, and activities, as well as cancer type, stage, and time since diagnosis. FINDINGS A fall occurred at a rate of 33% in older adults with cancer compared to 29% without cancer (p < 0.00). Those with a history of cancer were more likely to fall than those without cancer (adjusted odds ratio 1.16; 95% confidence interval [1.02, 1.33]; p = 0.03). No differences in fall rates were determined by cancer type or stage, and the odds of a fall did not increase when adding time since cancer diagnosis. CONCLUSIONS The fall rate was higher in older adults with cancer than in older adults without cancer. IMPLICATIONS FOR NURSING Nurses need to assess fall risk and initiate fall prevention measures for older adults at the time of cancer diagnosis. KNOWLEDGE TRANSLATION When caring for older adults with cancer, nurses should be aware of an increased risk for falls. Healthcare staff also should be aware of an increased risk for falls in that population during cancer treatment. Evidence-based fall prevention measures should be included in care plans for older adult cancer survivors.
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Hahn EE, Ganz PA, Melisko ME, Pierce JP, von Friederichs-Fitzwater M, Lane KT, Hiatt RA. Provider perceptions and expectations of breast cancer posttreatment care: a University of California Athena Breast Health Network project. J Cancer Surviv 2013; 7:323-30. [PMID: 23494652 DOI: 10.1007/s11764-013-0269-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening, and treatment. This qualitative research examines provider perceptions and expectations of posttreatment breast cancer care across five network sites with the goal of better understanding provider behavior during the posttreatment phase of the cancer care trajectory. METHODS Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of posttreatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software. RESULTS There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of posttreatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery. CONCLUSIONS These results identify a need for increased focus on care coordination during the posttreatment phase of breast cancer care within the University of California system and the potential for system and provider-level interventions that could help increase coordination of posttreatment care. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the posttreatment phase and lays a foundation for targeted interventions to increase adherence to evidence-based recommendations.
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Affiliation(s)
- Erin E Hahn
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, 650 Charles Young Drive South, Los Angeles, CA 90095-6900, USA.
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Health care utilization one year following the diagnosis benign breast disease or breast cancer. Breast 2012; 21:746-50. [DOI: 10.1016/j.breast.2012.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 01/25/2012] [Accepted: 01/29/2012] [Indexed: 11/18/2022] Open
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Tan ASL, Moldovan-Johnson M, Gray SW, Hornik RC, Armstrong K. An analysis of the association between cancer-related information seeking and adherence to breast cancer surveillance procedures. Cancer Epidemiol Biomarkers Prev 2012; 22:167-74. [PMID: 23118144 DOI: 10.1158/1055-9965.epi-12-0781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer surveillance is important for women with a known history of breast cancer. However, relatively little is known about the prevalence and determinants of adherence to surveillance procedures, including associations with seeking of cancer-related information from medical and nonmedical sources. METHODS We conducted a longitudinal cohort study of breast cancer patients diagnosed in Pennsylvania in 2005. Our main analyses included 352 women who were eligible for surveillance and participated in both baseline (~1 year after cancer diagnosis) and follow-up surveys. Outcomes were self-reported doctor visits and physical examination, mammography, and breast self-examination (BSE) at 1-year follow-up. RESULTS Most women underwent two or more physical examinations according to recommended guidelines (85%). For mammography, 56% of women were adherent (one mammogram in a year) while 39% reported possible overuse (two or more mammograms). Approximately 60% of respondents reported regular BSE (≥ 5 times in a year). Controlling for potential confounders, higher levels of cancer-related information seeking from nonmedical sources at baseline was associated with regular BSE (OR, 1.52; 95% CI, 1.01-2.29; P, 0.046). There was no significant association between information-seeking behaviors from medical or nonmedical sources and surveillance with physical examination or mammography. CONCLUSIONS Seeking cancer-related information from nonmedical sources is associated with regular BSE, a surveillance behavior that is not consistently recommended by professional organizations. IMPACT Findings from this study will inform clinicians on the contribution of active information seeking toward breast cancer survivors' adherence to different surveillance behaviors.
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Affiliation(s)
- Andy S L Tan
- University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104, USA.
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Treanor C, Donnelly M. An international review of the patterns and determinants of health service utilisation by adult cancer survivors. BMC Health Serv Res 2012; 12:316. [PMID: 22973899 PMCID: PMC3465193 DOI: 10.1186/1472-6963-12-316] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022] Open
Abstract
Background There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services. Methods Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review. Results Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provision s- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors. Conclusions Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.
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Affiliation(s)
- Charlene Treanor
- Cancer Epidemiology & Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK.
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Stordeur S, Vrijens F, Devriese S, Beirens K, Van Eycken E, Vlayen J. Developing and measuring a set of process and outcome indicators for breast cancer. Breast 2012; 21:253-60. [DOI: 10.1016/j.breast.2011.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/05/2011] [Accepted: 10/12/2011] [Indexed: 11/17/2022] Open
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Is Short-Interval Mammography Necessary After Breast Conservation Surgery and Radiation Treatment in Breast Cancer Patients? Int J Radiat Oncol Biol Phys 2012; 83:519-24. [DOI: 10.1016/j.ijrobp.2011.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/09/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022]
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Health Insurance and Other Factors Associated With Mammography Surveillance Among Breast Cancer Survivors. Med Care 2012; 50:270-6. [DOI: 10.1097/mlr.0b013e318244d294] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ. Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer. J Clin Oncol 2012; 30:813-9. [PMID: 22331949 DOI: 10.1200/jco.2010.34.4333] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This prospective study examined the factors that predicted sustained adherence to surveillance mammography in women treated for breast cancer. METHODS Breast cancer survivors (N = 204) who were undergoing surveillance mammography completed questionnaires assessing mammography-related anticipatory anxiety, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain. Adherence to mammography in the following year was assessed. RESULTS In the year after study entry, 84.8% of women (n = 173) returned for a subsequent mammogram. Unadjusted associations showed that younger age, shorter period of time since surgery, and having upper extremity lymphedema were associated with lower mammography adherence. Forty percent of women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0 to 10 scale). Although mammography pain was not associated with adherence, higher levels of mammography-related anxiety and pain catastrophizing were associated with not returning for a mammogram (P < .05). The impact of anxiety on mammography use was mediated by pain catastrophizing (indirect effect, P < .05). CONCLUSION Findings suggest that women who are younger, closer to the time of surgery, or have upper extremity lymphedema may be less likely to undergo repeated mammograms. It may be important for health professionals to remind selected patients directly that some women avoid repeat mammography and to re-emphasize the value of mammography for women with a history of breast cancer. Teaching women behavioral techniques (eg, redirecting attention) or providing medication for reducing anxiety could be considered for women with high levels of anxiety or catastrophic thoughts related to mammography.
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The health and well-being of cancer survivors in the UK: findings from a population-based survey. Br J Cancer 2011; 105 Suppl 1:S11-20. [PMID: 22048028 PMCID: PMC3251954 DOI: 10.1038/bjc.2011.418] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: To compare self-reported health and well-being in a sample of cancer survivors with individuals who have not had cancer and with individuals who have a serious chronic condition other than cancer. Patients and methods A cross-sectional survey drawn from an online panel of 400 000 UK citizens supplemented with other online recruitment and telephone recruitment. The participants were 4892 individuals 30 years of age or above, including 780 individuals with a previous cancer diagnosis, 1372 individuals with one or more of 10 chronic conditions but not cancer and 2740 individuals without a previous cancer diagnosis or chronic condition. Thirteen measures of health and well-being were constructed from answers to 25 survey items covering physical, psychological and social dimensions of health and well-being. Results: Cancer survivors were significantly more likely to report poor health outcomes across all 13 measures than those with no history of cancer or a chronic condition. The adjusted odds ratios for cancer survivors with no chronic conditions compared with healthy participants ranged from 1.37 (95% confidence interval (CI): 1.31–1.96) for emotional well-being to 3.34 (95% CI: 2.74–4.08) for number of health professionals consulted in the last 12 months. The health profile of cancer survivors was similar to those with a history of a serious chronic health condition. Conclusions: A substantial number of individuals who have had a diagnosis of cancer experience ongoing poor health and well-being following cancer and cancer treatment. The results of this study provide an initial basis for the development of specific help and support for cancer survivors.
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Grunfeld E, Hodgson DC, Del Giudice ME, Moineddin R. Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract 2011; 6:174-81. [PMID: 21037867 DOI: 10.1200/jop.200009] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Eva Grunfeld
- Ontario Institute for Cancer Research; Cancer Care Ontario Health Services Research Program; Department of Family and Community Medicine, University of Toronto; Institute of Clinical Evaluative Sciences, Sunnybrook Health Science Centre; Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Onega T, Cook A, Kirlin B, Shi X, Alford-Teaster J, Tuzzio L, Buist DSM. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat 2011; 129:269-75. [PMID: 21553117 DOI: 10.1007/s10549-011-1549-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.
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Affiliation(s)
- Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA.
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Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR. Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol 2011; 29:1101-9. [PMID: 21300931 DOI: 10.1200/jco.2010.28.8043] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The 2000 National Institutes of Health Consensus Conference on Adjuvant Therapy of Breast Cancer recommended chemotherapy for all women with invasive cancer greater than 1 centimeter. Studies of long-term breast cancer survivors have found poorer quality of life (QOL) in women who received adjuvant chemotherapy. The aim of this article is to characterize physical and psychosocial recovery as a function of chemotherapy receipt in the year after medical treatment completion. PATIENTS AND METHODS Prospective longitudinal survey data (RAND SF-36 and Breast Cancer Prevention Trial [BCPT] Symptom Scales) collected from 558 women with breast cancer enrolled on the Moving Beyond Cancer (MBC) psychoeducational intervention trial were compared according to receipt of chemotherapy. MBC study enrollment occurred within 4 weeks after the end of primary treatment (eg, surgery, chemotherapy, radiation). Self-report questionnaire data collected at enrollment and at 2, 6, and 12 months thereafter were examined, controlling for intervention and with propensity score adjustment for imbalance of covariates. Outcome analyses were carried out by fitting linear mixed models by using SAS PROC MIXED. RESULTS Longitudinal SF-36 scale scores did not differ by chemotherapy treatment exposure, and both groups improved significantly (P < .01) in the year after primary treatment ended. However, adjuvant chemotherapy treatment was associated with significantly more severe physical symptoms, including musculoskeletal pain (P = .01), vaginal problems (P < .01), weight problems (P = .01), and nausea (P = .03). CONCLUSION Physical and psychosocial functioning improved significantly after breast cancer treatment, independent of receipt of adjuvant chemotherapy. Women who received chemotherapy experienced more severe and persistent physical symptoms that should be more effectively managed as part of survivorship care.
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Affiliation(s)
- Patricia A Ganz
- School of Public Health, University of California, Los Angeles, CA 90095, USA.
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Craig BM, Bell BA, Quinn GP, Vadaparampil ST. Prevalence of cancer visits by physician specialty, 1997-2006. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:548-555. [PMID: 20336400 PMCID: PMC3811914 DOI: 10.1007/s13187-010-0100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 02/15/2010] [Indexed: 05/29/2023]
Abstract
Understanding the prevalence of cancer-related visits by physician specialty may help target educational and quality improvement initiatives. Using the 1997-2006 National Ambulatory Medical Care Survey, adult ambulatory visits (N = 161,278) were classified by cancer diagnosis and patients' characteristics and compared with physician specialty. The prevalence of cancer visits within each specialty varied from 0% to 62%. Aside from hematology/oncology (hem/onc) specialties, nine surgical specialties and four medical specialties had more than 1% cancer visits. Cancer patients with private insurance or Medicaid coverage were less likely to see hem/onc specialists compared to Medicare patients. Whereas hem/onc specialists primarily see cancer patients, general surgeons and primary care physicians provide a large amount of cancer services, particularly to underinsured patients. Thus, when trying to contact cancer patients or their physicians, health administrators, researchers, and practitioners should consider targeting general surgeons and primary care physicians in addition to hem/onc specialists.
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Affiliation(s)
- Benjamin M Craig
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612-9416, USA.
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BRENNAN ME, BUTOW P, SPILLANE AJ, BOYLE FM. Survivorship care after breast cancer: Follow-up practices of Australian health professionals and attitudes to a survivorship care plan. Asia Pac J Clin Oncol 2010; 6:116-25. [DOI: 10.1111/j.1743-7563.2010.01286.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hollowell K, Olmsted CL, Richardson AS, Pittman HK, Bellin L, Tafra L, Verbanac KM. American Society of Clinical Oncology-recommended surveillance and physician specialty among long-term breast cancer survivors. Cancer 2010; 116:2090-8. [PMID: 20198707 DOI: 10.1002/cncr.25038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether it is appropriate to transfer the follow-up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long-term surveillance of survivors who underwent surgery at an American academic center. METHODS Women in this institutional review board-approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow-up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care. RESULTS The majority of patients (90%; n = 242) were followed by specialists with 10% (n = 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO-recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow-up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at Year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%; P = .001-.02). CONCLUSIONS Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice.
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Affiliation(s)
- Kerry Hollowell
- Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA
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Cancer screening practices among racially and ethnically diverse breast cancer survivors: results from the 2001 and 2003 California Health Interview Survey. J Cancer Surviv 2009; 4:1-14. [DOI: 10.1007/s11764-009-0102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 10/21/2009] [Indexed: 11/26/2022]
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The potential of survivorship care plans in primary care follow-up of minority breast cancer patients. J Gen Intern Med 2009; 24 Suppl 2:S467-71. [PMID: 19838852 PMCID: PMC2763149 DOI: 10.1007/s11606-009-1012-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND When the clinical care of minority breast cancer survivors is transferred from oncology settings to primary care, quality of care may be compromised if their primary care providers do not have adequate cancer treatment records and follow-up care guidelines. Survivorship care plans (SCPs) given to survivors before they transition to primary care settings are designed to improve the transfer of this information. This study examined these issues in a sample of minority breast cancer survivors. DESIGN During four focus groups with minority breast cancer survivors, data were collected about the types of information survivors remember receiving from their oncologists about follow-up health care needs. Survivors were also asked their opinions on the value and content of a survivorship care plan. RESULTS Minority breast cancer survivors received variable amounts of information about their cancer treatments. They were dissatisfied with the amount of information they received on cancer-related side-effects, including race-specific information. The American Society of Clinical Oncology's breast cancer survivorship care plan was viewed as important, but too highly technical and limited in information on side-effects and self-care approaches. CONCLUSIONS Survivorship care plans may help increase information transfer from oncologists to patients and primary care providers, but the content of care plans needs to be adapted to minority patients' concerns. Primary care physicians may be challenged by survivors to explain recommended surveillance guidelines and to respond to untreated physical and psychosocial problems.
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Sanson-Fisher R, Carey M, Mackenzie L, Hill D, Campbell S, Turner D. Reducing inequities in cancer care: the role of cancer registries. Cancer 2009; 115:3597-605. [PMID: 19479975 DOI: 10.1002/cncr.24415] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Nekhlyudov L, Habel LA, Achacoso NS, Jung I, Haque R, Collins LC, Schnitt SJ, Quesenberry CP, Fletcher SW. Adherence to long-term surveillance mammography among women with ductal carcinoma in situ treated with breast-conserving surgery. J Clin Oncol 2009; 27:3211-6. [PMID: 19433691 DOI: 10.1200/jco.2008.18.5876] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Breast-conserving surgery (BCS) is an effective treatment for ductal carcinoma in situ (DCIS) but women who undergo BCS remain at risk for recurrences. Whether mammographic surveillance after BCS occurs and by whom is not known. METHODS We reviewed medical records of women diagnosed with DCIS between 1990 and 2001 and treated with BCS. Using descriptive statistics, generalized estimating, and logistic regression modeling, we examined the rates and predictors of surveillance mammography over a 10-year period after BCS. Results The cohort included 3,037 women observed for a median of 4.8 years (range, 0.5 to 15.7). Of the 2,676 women observed for at least 1 year after BCS, most (79%) had at least one surveillance mammogram during the first year of follow-up; 69% in year 5 and 61% in year 10. Among those observed for 5 years, surveillance mammograms were more likely among women age 60 to 69 years (odds ratio [OR], 1.72; 95% CI, 1.26 to 2.34), users of menopausal hormone therapy at diagnosis (OR, 1.26; 95% CI, 1.01 to 1.57) as well as those treated with adjuvant radiation (OR, 1.28; 95% CI, 1.08 to 1.53) and adjuvant radiation with tamoxifen (OR, 1.61; 95% CI, 1.13 to 2.30). Surveillance mammograms were less likely among obese women (OR, 0.70; 95% CI, 0.56 to 0.86). The findings were similar among women observed for 10 years. Only 34% and 15% of women observed for 5 and 10 years, respectively, had a surveillance mammogram during each year of follow-up. CONCLUSION Surveillance mammography after BCS among insured women with DCIS often did not occur yearly and declined over time after treatment. Patients and providers must remain vigilant about surveillance after BCS.
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Affiliation(s)
- Larissa Nekhlyudov
- Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA.
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Screening mammography rate and predictors following treatment for colorectal cancer. J Cancer Surviv 2009; 3:12-20. [DOI: 10.1007/s11764-009-0080-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
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Campbell JD, Ramsey SD. The costs of treating breast cancer in the US: a synthesis of published evidence. PHARMACOECONOMICS 2009; 27:199-209. [PMID: 19354340 DOI: 10.2165/00019053-200927030-00003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Published estimates for the treatment costs of breast cancer vary widely in methodology, perspective, patient populations and time horizon. We systematically summarized and analysed the published literature on per-patient costs of breast cancer, and highlight the perspectives, populations studied, time horizons and future directions for cost studies in breast cancer. This review included 29 US cost-of-illness studies for breast cancer. The estimates of lifetime per-patient costs of breast cancer ranged from $US20 000 to $US100 000. Payer perspectives were popular, while disease stages I and II were emphasized. The costs of initial and terminal therapy were greater than continuing care on a per-unit time basis, but continuing care accounts for the largest share of lifetime cost due to the relatively long survival of breast cancer patients. Costs of different surgeries were relatively similar (breast-conserving surgery vs mastectomy) but, all else equal, significant costs ($US23 000-31 000) were observed for patients who received adjuvant chemotherapy compared with those who did not. Multiple studies confirmed that costs increased with increased stage of disease and costs decreased with increased age of diagnosis. The question remains whether or not lower costs for elderly patients are associated with lower quality of care. The patient, employer and societal perspectives were rarely presented. Experts in the field have recommended the societal perspective for US-based cost-effectiveness analyses. Most lifetime cost estimates were likely an underestimate for today's lifetime cost of treating breast cancer because of changes in practice patterns and improved survival. Further societal-based cost studies that differentiate costs by stage, age and treatment time (initial, continuing and terminal), and include the latest practice patterns would be valuable toward informing US-based cost-effectiveness studies for preventive as well as breast cancer treatment interventions.
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Mandelblatt JS, Cullen J, Lawrence WF, Stanton AL, Yi B, Kwan L, Ganz PA. Economic evaluation alongside a clinical trial of psycho-educational interventions to improve adjustment to survivorship among patients with breast cancer. J Clin Oncol 2008; 26:1684-90. [PMID: 18375897 DOI: 10.1200/jco.2007.14.0822] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is little economic research on psychosocial interventions. We aimed to collect data alongside a randomized trial to compare the costs and benefits of three psycho-educational strategies to improve transition to cancer survivorship. METHODS We evaluated the incremental delivery costs per unit increase in energy (using the Medical Outcomes Study vitality scale) or decrease in distress (from the Revised Impact of Events Scale) in the 6 months postintervention. We also evaluated 1-year post-treatment health care costs. RESULTS The costs of the control, video, and video plus counseling arms were $11.30, $25.85, and $134.47 per person, respectively. The video costs were $2.22 per unit increase in energy compared with control; among women who were the least prepared for transition, the video was more effective, resulting in even lower costs. The video cost $7,275 per unit change in distress versus control, but costs were lower in the subgroup least prepared for transition ($355). The counseling arm was more expensive and less effective than the video for virtually all end points. However, in one group, women more prepared for transition, counseling cost $1,066 per unit decrease in distress compared with the video. Health care costs tended to increase as intervention intensity increased. CONCLUSION There are no standards for evaluating cost-effectiveness of trials with psychosocial end points. In this trial, the educational video was the most cost-effective way to improve transition to survivorship. It will be important to confirm whether there is an increased use of services after such interventions and if this represents appropriate use of rehabilitative and supportive care or over-use.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Ave, Suite 4400, Washington, DC 20007, USA.
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Is a short-interval postradiation mammogram necessary after conservative surgery and radiation in breast cancer? Int J Radiat Oncol Biol Phys 2008; 72:1041-7. [PMID: 18407428 DOI: 10.1016/j.ijrobp.2008.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 02/09/2008] [Accepted: 02/12/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To examine, in a retrospective study, whether the initial posttreatment mammogram offers any benefit to patients. METHODS AND MATERIALS Patients were selected who had radiation after breast-conservation therapy from 1995 through 2005 and had follow-up mammography at the University of California-Los Angeles (UCLA) within 1 year of completing radiotherapy. Results of the initial follow-up mammogram were analyzed to determine the yield of this initial mammogram. RESULTS Between 1995 and 2005, 408 patients treated with breast-conserving therapy and radiation had follow-up mammograms at UCLA within 1 year of completion of radiation. Median age at radiation completion was 56.9 years. Median interval between radiation and the initial mammogram was 3.1 months. Ten patients were found to have suspicious findings on the initial postradiation mammogram, prompting biopsy, but only 2 were found to have recurrent cancer. None of those lesions were palpable. In both cases the recurrences were ductal carcinoma in situ. Thus, the yield of the initial postoperative mammogram as compared with physical examination findings is estimated at 0.49 recurrences detected per 100 mammograms performed (95% confidence interval 0.059-1.759). CONCLUSIONS The yield of the initial postradiation mammography at UCLA seems to be low, and only noninvasive carcinomas were found. Our data support the rationale to avoid the initial short-interval postradiation mammography and evaluate patients at 12 months.
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Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, Schwartz K, Katz SJ. Symptom Experience and Quality of Life of Women Following Breast Cancer Treatment. J Womens Health (Larchmt) 2007; 16:1348-61. [PMID: 18001192 DOI: 10.1089/jwh.2006.0255] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Nancy K. Janz
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Mahasin Mujahid
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Lynna K. Chung
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Paula M. Lantz
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Monica Morrow
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Kendra Schwartz
- Department of Family Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Steven J. Katz
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Schootman M, Jeffe DB, Lian M, Aft R, Gillanders WE. Surveillance mammography and the risk of death among elderly breast cancer patients. Breast Cancer Res Treat 2007; 111:489-96. [PMID: 17957465 DOI: 10.1007/s10549-007-9795-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 10/12/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the benefits of mammography for elderly breast cancer survivors in community settings. METHODS Using the 1991-1999 linked SEER-Medicare data, we examined if mammography reduced the risk of breast-cancer-specific and all-cause mortality among women age 66 or older who were diagnosed with first primary breast cancer (FPBC) at stages 0-III and survived at least 30 months. To analyze the influence of mammography (both within one year and within two years prior to death/censoring) on the risk of breast-cancer-specific mortality, we compared women who died of breast cancer (cases) with women who died of other causes or were censored (controls). For an analysis of all-cause mortality, we compared women who died from any cause (cases) with women who were censored (controls). Propensity scores were used to adjust for tumor-related, treatment-related, and sociodemographic confounders. RESULTS Among 1351 breast cancer deaths (cases) and 5,262 controls, women who had a mammogram during a one or two-year time interval were less likely to die from breast cancer than women who did not have any mammograms during this time period in propensity-score-adjusted analysis (within one year odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.72-0.95; within two years OR: 0.80, 95% CI: 0.70-0.92). Similarly, risk of all-cause mortality was reduced among women who had mammograms during one- or two-year intervals. CONCLUSIONS In community settings, mammography use during a one- or two-year time interval was associated with a small-reduced risk of breast-cancer-specific and all-cause mortality among elderly breast cancer survivors.
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Affiliation(s)
- Mario Schootman
- Department of Medicine and Pediatrics, Washington University School of Medicine, Saint Louis, MO, 63108, USA.
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