236658 Comparison of post-treatment breast cancer surveillance strategies among oncology specialties

Tuesday, November 1, 2011: 4:30 PM

Rina Parmeshwar, BS , School of Medicine, St. Louis University, St. Louis, MO
Emad Allam, MD , Saint Louis University, St. Louis, MO
Katherine S. Virgo, PhD, MBA , Health Services Research Division, Surveillance & Health Policy Research Dept., American Cancer Society, Atlanta, GA
Julie Margenthaler, MD , Department of Surgery, Washington University, St. Louis, MO
Ling Chen, PhD , Division of Biostatistics, Washington University, St. Louis, MO
Frank E. Johnson, MD , Dept. of Surgery, Saint Louis University & Saint Louis VAMC, Saint Louis, MO
Introduction: American Society of Clinical Oncology (ASCO) guidelines currently recommend only clinic visits and mammograms for post-treatment surveillance of breast cancer. We compared the intensity of breast cancer patient surveillance after initial breast cancer therapy and quantified differences in post-treatment surveillance practices among radiation oncologists (RO), medical oncologists (MO) and surgeons (SO). Methods: We designed a survey instrument with 4 patient vignettes. We emailed them to the 3245 ASCO members who identified themselves as having breast cancer as a major focus of their practice. Responses were grouped for all 4 vignettes and median, range, mean and standard deviation of frequency of use for 12 surveillance modalities were determined. Results: There were 1012 total responses; 846 were evaluable. 70% were from MO, 5% were from RO, 10% were from SO and 15% were unspecified. Significant variation across specialties was evident and all 10 modalities not recommended by ASCO guidelines were utilized by some clinicians. In year 1, MO requested 1.6 1.6 (mean SD) mammograms; RO requested 1.7 0.9; SO requested 1.4 0.6 (p> 0.4). In year 1, MO recommended 3.5 1.6 (mean SD) office visits, RO recommended 3.1 1.4 and SO recommended 3.0 1.7. These differences were statistically significant (p< 0.001, ANOVA) but clinically small. Conclusions: Improved medical education is needed to inform clinicians and trainees about evidence from randomized controlled trials regarding optimal post-treatment surveillance, as there is significant variation among specialties in their use of surveillance modalities.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Identify evidence that modalities utilized in breast cancer surveillance after curative-intent primary treatment often do not follow ASCO guidelines.

Keywords: Breast Cancer, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am a surgical oncologist who takes care of breast cancer patients.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.