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Discontinuation of Follow-up Care Among Women With Early-Stage Breast Cancer

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Key Points

  • In total, 21% of women discontinued follow-up care over 5 years from diagnosis.
  • Factors in discontinuation included older age, hormone receptor–negative disease, low tumor grade, single vs married status, less recent year of diagnosis, and lower disease stage.

In a study using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data reported in the Journal of Oncology Practice, Quyyumi et al found that 21% of women with early-stage breast cancer discontinued follow-up care within 5 years after diagnosis.

Study Details

The study involved data on 30,053 women aged ≥ 65 years diagnosed with stage I or II breast cancer who underwent breast-conserving surgery within 6 months of diagnosis between January 2002 and December 2007. Follow-up was through December 2012. Discontinuation of follow-up was defined as a period > 12 months from the previous physician visit without a visit claim from a surgeon, medical oncologist, or radiation oncologist.

Discontinuation and Associated Factors

Of the 30,053 patients, 25,781 (85.8%) saw a medical oncologist and 21,612 (71.9%) a radiation oncologist in the first year in addition to their surgeon; 66% saw all 3 providers during the first year. By 5 years, 6,302 patients (21.0%) discontinued follow-up visits with any oncology provider. On multivariate analysis, factors significantly associated with discontinuation (all P < .05) were increasing age (hazard ratios of 1.11, 1.21, and 1.68 for 70–74, 75–79, and ≥ 80-year age groups vs age 65–69 years), presence of hormone receptor–negative disease (HR = 1.14), low vs high tumor grade (HR = 1.07), and single vs married status (HR = 1.09). Factors significantly associated (P < .05) with reduced likelihood of discontinuation were stage II vs stage I disease (HR = 0.83) and more recent year of diagnosis (HR = 0.96).

Overall, the number of patients seeing only a medical oncologist increased each year, with visits to only a radiation oncologist or surgeon decreasing in years 2 to 5; by year 5, the majority of patients had fewer than two visits with an oncology provider.

The investigators concluded, “Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.”

The study was supported by grants from the ASCO/Breast Cancer Research Foundation and National Cancer Institute.

Dawn L. Hershman, MD, of Columbia University Medical Center, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: See study authors’ full disclosures at jop.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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