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Analysis

1 in 5 Early-Stage Breast Cancer Patients Abandon Follow-Up Care

By Christopher Cheney  
   April 01, 2019

New research helps identify which breast cancer patients are likely to quit going to follow-up visits.

Within the five years following a diagnosis for Stage I or II breast cancer, 21% of patients stop seeing physicians for follow-up care, a recent study says.

Breast cancer is the second most common form of cancer for American women, with about 12% of women developing the condition, according to the American Cancer Society. Breast cancer has a high level of lethality—only lung cancer kills more women annually.

The corresponding author of the recent research, which was published in the Journal of Oncology Practice, told Healthleaders that there are several reasons why follow-up care is crucial for recovery.

"It is important for patients to know that during follow-up appointments they are being evaluated for recurrence, evaluated for early detection of new primary tumors, and to make sure they are up to date with other cancer prevention activities. In addition, information is rapidly changing, so keeping up with the oncologist is important to make sure the care is current," said Dawn Hershman, MD, MS, a professor of medicine and epidemiology at Columbia University Medical Center in New York.

Hershman's research team examined data from more than 30,000 patients who were 65 and older. They found several key points.

  • In the first year after diagnosis, 85.8% of patients saw a medical oncologist and 71.9% saw a radiation oncologist in addition to a surgeon
     
  • Two-thirds of the patients visited all three kinds of providers in the first year after diagnosis
     
  • In the five years after diagnosis, 21% of patients stopped follow-up visits
     
  • Factors predictive of discontinued follow-up care included older age, single relationship status, patients with low-grade tumors, and patients with hormone receptor-negative breast cancer

Encouraging follow-up care
 

Surgeons and oncology specialists can take steps to increase follow-up care for breast cancer, the researchers wrote.

"Coordination of follow-up care between oncology specialists and other providers may reduce discontinuation rates as well as the redundancy of visits, thereby increasing clinical efficiency. Identifying patients who are at risk for early discontinuation of follow-up will eventually allow for the promotion of public health initiatives to improve access to care," they wrote.

Hormone therapy should be a focal point of public health efforts, Hershman told HealthLeaders. "The most important thing we do during follow-up is to make sure women on hormone therapy stay on their hormone therapy. Making sure these treatments are available to everyone is an important public health initiative."

Educating breast cancer patients about the seriousness of follow-up care is essential, she said. "As a provider, it is hard to know when patients stop following up. Sometimes, patients move or change providers. Patients need to be active in making sure they follow with at least one provider."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Breast cancer is a common and highly lethal form of cancer among American women.

For women 65 and older, the rate of follow-up care for breast cancer drops significantly in the five years after diagnosis.

Efforts to increase breast cancer follow-up care include patient education as well as care coordination between surgeons and oncology specialists.


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