MedWire News: Cancer specialists provide more consistent and comprehensive American Society of Clinical Oncology (ASCO)-recommended breast cancer follow-up care than primary care physicians (PCPs), US research shows.
“Compliance with current surveillance guidelines needs improvement among all providers,” remark Kathryn Verbanac (East Carolina University, Greenville, North Carolina) and colleagues.
Verbanac and team note that it is unclear whether it is appropriate to transfer the follow-up care of breast cancer survivors from cancer specialists to PCPs. They therefore carried out a retrospective study to determine the impact of physician specialty on follow-up medical care.
The researchers reviewed medical records from 270 patients with stage I to III breast cancer who underwent breast surgery between 1996 and 2006. They compared the patients’ follow-up over an average of 6 years with the ASCO guidelines for recommended surveillance frequency and care.
The team found that most (90%) of the patients received follow-up from a specialist with 10% followed-up by PCPs. Patients followed-up by specialists tended to present with more advanced disease and were at greater risk for disease recurrence than those followed-up by PCPs.
Specialists more frequently followed-up patients at ASCO-recommended intervals, when compared with those followed-up by PCPs. This difference became greater and more significant over time. At 6 years, 89% of patients under specialist care received the recommended follow-up compared with 69% of patients receiving PCP care; however, many patients were followed-up inconsistently.
Compared with women seen by PCPs, those seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%). In addition, breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% of patients).
“Surveillance of breast cancer survivors should occur more thoroughly and consistently at every recommended interval, regardless of whether the women are followed by a PCP or a specialist, and physical examinations and imaging should be better documented,” Verbanac et al conclude.
They add: “If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities.”
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