PI: Hemalkumar B. Mehta, PhD
The primary goal of surveillance following curative treatment for cancer, regardless of site, is to detect local recurrence or distant disease at a time when survival can be prolonged by interventions designed to cure or at least treat the disease more effectively than when discovered later. Evidence-based recommendations regarding surveillance can decrease variations in care, limit unnecessary care, and serve to facilitate the delivery of necessary care. The availability of evidence-based recommendations varies significantly among different cancer types. Based on randomized, controlled data, the surveillance recommendations for breast and colorectal cancer are clear. In contrast, few to no evidence-based recommendations exist for post-treatment surveillance for cancers such as lung and pancreas. In national studies using both administrative data and single-institution data, we and others have identified wide variation in post-treatment surveillance with respect to evidence-based recommendations. Despite clear recommendations, surveillance practices vary significantly by patient demographics, cancer type, and the type and number of physicians (primary care physicians vs. specialists) performing the surveillance.
We initially used the Texas Cancer Registry and linked Medicare, Medicaid, and private insurance claims data from 2000-2012 to address the following specific aims:
- Describe the patterns of surveillance testing after curative treatment for breast and colorectal cancer patients compared to available evidence-based recommendations and describe the cost of guideline adherent and non-adherent post-treatment surveillance.
- Describe the patterns of surveillance testing after curative treatment for non-small cell lung and pancreatic cancer patients.
- Describe physician visits after curative-intent cancer treatment, including the proportion of patients with regular visits to primary care physicians, surgeons, medical oncologists, and/or radiation oncologists, as well as the proportion of patients who see multiple provider types for each of the four cancers.
- Assess the effects of patient characteristics, provider characteristics, health care delivery factors, and time on guideline-adherent surveillance testing, overuse of testing, and underuse of testing.
Our analysis allows us to examine the reasons for both overuse and underuse of surveillance tests and will yield important information to guide state-level decision-making and allocation of resources to optimize post-treatment cancer surveillance in Texas.
We ask questions including, but not limited to, the following:
- Is there significant ethnic variation in post-treatment surveillance?
- Does the overuse of post-treatment surveillance correlate with high per capita Medicare spending in different geographic regions?
- How do surveillance patterns differ by physician specialty?
- Does care by multiple providers lead to repetitive or duplicative testing?
Given the lack of evidence-based recommendations, we cannot evaluate the overuse or underuse of post-treatment surveillance in lung and pancreatic cancer. However, studying the patterns of post-treatment surveillance for these unstudied cancers will allow us to describe current patterns and identify potential overuse, such as repetitive testing.
