American Society of Clinical Oncology‐recommended surveillance and physician specialty among long‐term breast cancer survivors

BACKGROUND: It is unclear whether it is appropriate to transfer the follow‐up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long‐term surveillance of survivors who underwent surgery at an American academic center. METHODS: Women in this institutional review board‐approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow‐up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care. RESULTS: The majority of patients (90%; n = 242) were followed by specialists with 10% (n = 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO‐recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow‐up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women 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%; P = .001‐.02). CONCLUSIONS: Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow‐up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice. Cancer 2010. © 2010 American Cancer Society. Compliance with current surveillance guidelines needs improvement among all providers. Specialists more consistently followed American Society of Clinical Oncology guidelines for surveillance frequency and care. If transfer of care to a primary care physician occurs, it should be formalized and include follow‐up recommendations and defined physician responsibilities.