259702 Surveillance after primary therapy for breast carcinoma – what motivates clinical experts?

Tuesday, October 30, 2012

Harveshp Mogal, MD , Surgery, Saint Louis University, Saint Louis, MO
Emad Allam, MD , Saint Louis University, St. Louis, MO
Julie A. Margenthaler, MD , Department of Surgery, Washington University, St. Louis, MO
Ling Chen, PhD , Division of Biostatistics, Washington University, St. Louis, MO
Katherine S. Virgo, PhD, MBA , Managing Director, Health Services Research/ Intramural Research, American Cancer Society National Home Office, Atlanta, GA
Frank E. Johnson, MD , Dept. of Surgery, Saint Louis University, Saint Louis, MO
PURPOSE: Breast cancer is the most common cancer among American women except for skin cancer. About 1 in 8 women develop breast cancer in their lifetime. Breast carcinoma is diagnosed in over 200,000 patients annually in the U.S. Most receive curative-intent treatment. There are over 2.5 million women with a history of breast cancer now alive who are eligible for surveillance. The American Society of Clinical Oncology (ASCO) has published evidence-based guidelines for surveillance after primary breast cancer treatment. However, we have demonstrated dramatic variation in the actual practice patterns of ASCO clinicians. We sought to evaluate potential factors that motivate these experts in designing their own surveillance strategies. METHODS: We sent an e-mail survey instrument with 11 questions about potential motivating factors to the 3245 ASCO members who had indicated that breast cancer was a major focus of their clinical practice. Responses were submitted on a 10-level Likert scale. The percentage of responses for each point on the scale for each of the 11 putative motivating factors was tabulated. The motivation factors were ranked as least or most important depending on the percentage of responses on the Likert scale score. The least important motivating factor was the one with the highest percentage score of 1. The most important motivating factor was the one with the highest percentage score of 10. RESULTS: 1013 responses (31%) were submitted, of which 734 (73%) were evaluable. “Avoidance of medical malpractice lawsuits” was the weakest motivating factor (26% with a score of 1). “Detection of a second primary breast cancer” was the strongest motivating factor (53% with a score of 10). CONCLUSIONS: We believe our study is the first of its kind to evaluate factors that potentially motivate expert clinicians in selecting their surveillance strategies after primary treatment of breast cancer. Understanding these factors may permit the development of strategies to reduce non-compliance with evidence-based guidelines and minimize the present variation in practice patterns. This should reduce overuse, underuse and/or misuse of costly resources, which will be particularly important in the national healthcare system now being implemented.

Learning Areas:
Implementation of health education strategies, interventions and programs
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Social and behavioral sciences

Learning Objectives:
1) Demonstrate awareness that breast cancer surveillance practices among ASCO members often do not comply with ASCO surveillance guidelines. 2) List what factors motivate ASCO experts in designing surveillance strategies for their own breast cancer patients after initial curative-intent therapy.

Keywords: Surveillance, Breast Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a surgical oncologist who cares for 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.