In a prospective cohort study published in JCO Oncology Practice, Ssebyala et al examined long-term health-care utilization and adherence to follow-up care among young adult survivors of breast cancer. Their findings reveal high rates of mammography adherence but persistent gaps in other areas of preventive and primary care.
Study Details
Drawing from data from the Young Women’s Breast Cancer Study, the authors aimed to characterize how survivors diagnosed at age ≤ 40 years navigate survivorship care 7 years after diagnosis. The multicenter, prospective cohort study enrolled 1,302 women diagnosed with stage 0 to III breast cancer between 2006 and 2016 across 13 sites in the United States and Canada. Of these participants, 660 (median age = 37 years) were included in the 7-year follow-up analysis. Most women presented with stage I (37%) or stage II (42%) disease, almost three-quarters had received chemotherapy, and almost two-thirds had undergone radiation therapy.
Key Takeaways
After an initial review, patients were surveyed every 6 months for the first 3 years and then annually. At 7 years after diagnosis, most participants (92%) reported having a primary care provider (PCP). However, more than half (57%) continued to rely exclusively on oncology providers for cancer-related follow-up, whereas 12% had transitioned entirely to PCP-led care. About 29% saw both oncology and primary care providers for follow-up care related to their cancer.
Among women with remaining breast tissue (after lumpectomy or unilateral mastectomy), 82% reported having a mammogram within the past year. Bone density scans (restricted to patients receiving endocrine therapy) were less prevalent, with only 42% undergoing this test in the prior 2 years. Preventive health measures such as influenza vaccination, Pap testing or pelvic examinations, and cholesterol screening were also suboptimal.
Multivariate analyses identified several predictors of follow-up patterns. Women with stage 0 vs stage I disease were more likely to see only a PCP (odds ratio [OR] = 2.74, 95% confidence interval [CI] = 1.10–6.80), and patients receiving endocrine therapy (OR = 0.31, 95% CI = 0.16–0.58) or those with greater fear of recurrence (OR = 0.23, 95% CI = 0.12–0.47) tended to consult oncologic specialists as well as PCPs.
HER2-positive disease was associated with higher adherence to mammography, whereas BRCA mutation carriers and those who had undergone unilateral mastectomy were less adherent. Conversely, bone density scans were more likely among women who received chemotherapy and those carrying BRCA mutations.
According to the study authors, the variability in follow-up care among young survivors of breast cancer highlights the need for better coordination between oncology and primary care physicians, as well as interventions to address patient-level barriers such as fear of recurrence.
“Future research to identify specific barriers and facilitators to delivery and receipt of guideline-concordant follow-up care at the patient, provider, and system levels may inform multilevel strategies to optimize survivorship care in this population,” the authors concluded.
Shakirah N. Ssebyala, MD, of Weill Cornell Medicine, New York, is the corresponding author of the JCO Oncology Practice article.
Disclosure: For full disclosures of all study authors, visit ascopubs.org.
