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APHA Scientific Session and Event Listing

Recorded presentation

Frank E. Johnson, MD¹, Randal C. Paniello, MD², Michael H. Johnson, BS³, and Katherine S. Virgo, PhD, MBA³. (1) Surgery, Saint Louis University, 3635 Vista Avenue, St. Louis, MO 63110, 314-577-8316, frank.johnson@med.va.gov, (2) Otolaryngology, Washington University, 660 S. Euclid Avenue, St. Louis, MO 63110, (3) St. Louis Department of Veterans Affairs Medical Center, 915 N. Grand, St. Louis, MO 63106

Overuse, underuse, and misuse of resources are common in medical care. Efforts to minimize inappropriate use are widely advocated. We measured the intensity of surveillance after surgery for upper aerodigestive tract carcinoma via a survey of the membership of the American Head and Neck Society. Substantial variation in practice was noted among these experts. We investigated the role of geographic factors in this variation using repeated-measures analysis of variance, controlling for tumor stage and post-operative year. Of the 1,322 members surveyed, 610 (46%) responded, of which 420 (32%) were evaluable. Pooled responses from nine US census regions, 12 metropolitan statistical areas (MSAs), and overseas members (16% of evaluable responses) were compared. There were statistically significant variations in practice patterns among census regions for office visits, CBC, head-neck CT, sonography, and esophagoscopy (p<0.05). The mean frequency of office visits also differed significantly (p<0.05) among MSAs, ranging from six in Houston to nine elsewhere during year 1 for patients with stage I lesions. Non-US members use significantly more blood tests, imaging studies, and endoscopy for routine cancer surveillance than US members (p<0.05). Surprisingly, the penetration rate of managed care organizations had no significant effect on post-treatment surveillance intensity. This analysis indicates that only a small portion of the wide variation in observed follow-up practice patterns can be explained by geographic determinants.

Learning Objectives:

• Understand how surgeon age affects post-operative follow-up intensity after treatment for upper aerodigestive tract carcinoma.
• Apply this information in the design of trials of alternative follow-up strategies for upper aerodigestive tract cancer patients.
• Compare the surveillance intensity of expert clinicians with actual practice in an institution of interest to the participant.

Keywords: Cancer Screening, Clinical Trials

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation