Abstract P5-13-06: Factors associated with follow up medical care among women with early stage breast cancer
Authors: Hershman DL , Quyyumi F , Accordino MK , Buono DL , Neugut AI , Hillyer GC , Wright JD 
Published: March 2017

Abstract
Introduction: In patients with early stage breast cancer treated with curative intent, optimal follow-up guidelines vary widely among national organizations. NCCN guidelines suggest patients should be followed by a medical oncologist (MO) every 3-6 months and by a radiation oncologist (RO) every 6-12 months for the first 5 years. These recommendations are not evidence based and have an unknown effect on cancer outcomes. We sought to evaluate the patterns of follow-up care and predictors of discontinuation of follow-up care.
Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we evaluated patients diagnosed with stage I and II breast cancer who underwent surgery from 2002-2007 with follow-up to 2012. Patients who died in the 5-year period following diagnosis were excluded. We evaluated patterns of follow-up visits for the 5 years after diagnosis among surgeon, MO and RO. We defined discontinuation of follow-up care as &gt;12 months without a visit claim from any of the three providers. We performed a Cox-proportional hazards multivariate analysis to determine factors associated with discontinuation of follow-up care. Patients were censored if a new cancer was diagnosed.
Results: A total of 35,484 stage I and II breast cancer patients were included in the analysis. In addition to the surgeon, 77.5% saw a MO, and 57.8% saw RO in the first year. The mean number of total physician appointments for years 1-5 were 9.4, 3.3, 2.4, 2.0 and 1.7, respectively. During the 5 years, 13,908 (39.6%) patients discontinued follow-up visits. The discontinuation rate averaged about 12% per year for years 2-5. Discontinuing physician visits increased with increasing age. Patients who saw all 3 physicians in year 1 were less likely to discontinue follow-up visits (OR = 0.54, 0.51-0.57). Patients were more likely to discontinue physician visits if they were hormone receptor negative (HR = 1.41, 1.33-1.49), were black (HR = 1.14, 1.06-1.22) or Hispanic (HR = 1.36, 1.17-1.58) compared to white, lived in a rural as opposed to urban setting (HR 1.12, 1.05-1.18), were unmarried (HR = 1.16, 1.12-1.20), had a higher comorbidity score (HR = 1.15, 1.10-1.21), or were in a lower SES quintile (HR = 1.08, 1.02-1.15). Women who had a mastectomy (vs lumpectomy) (HR =0.83, 0.80-0.87) and those who were receiving chemotherapy (HR = 0.55, 0.52-0.59) or radiation therapy (OR = 0.60, 0.57-0.62) were less likely to discontinue physician visits.
Conclusions: Clinical practice guidelines for surveillance of breast cancer after primary treatment are based on expert opinion and have an unclear effect on long-term outcomes. Coordination of follow-up care may reduce discontinuation. More research is needed to determine the optimal follow-up for maintaining adherence to therapy, reducing over-testing and encouraging secondary cancer screening guidelines.
Citation Format: Hershman DL, Quyyumi F, Accordino MK, Buono DL, Neugut AI, Hillyer GC, Wright JD. Factors associated with follow up medical care among women with early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-06.