Women who have been treated for early-stage breast cancer and receive surveillance testing are at risk of adverse events and increased financial burden, according to research that will be presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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ASCO’s Choosing Wisely guidelines recommend against routine surveillance testing or imaging for asymptomatic individuals with early-stage breast cancer who have undergone treatment. Previous studies have shown that no benefit exists for such patients, and false-positive results can lead to unnecessary procedures, radiation exposure, misdiagnosis, and possible overtreatment. However, testing or imaging are frequently performed despite these guidelines, and the ramifications of such surveillance has yet to be assessed.
Gary Lyman, MD, MPH, breast cancer oncologist, Hutchinson Institute for Cancer Outcomes Research (Seattle, WA), and colleagues examined physician specialty and costs associated with surveillance testing and imaging in patients with early-stage breast cancer. A total of 2193 patients from 2007 to 2015 who had been diagnosed with stage I/II breast cancer and treated with mastectomy or lumpectomy plus radiation were sampled. Surveillance was considered from the first 4-month gap in treatment through 13 months or restart of treatment.
Results of the analysis showed that 37% of patients received tumor-marker tests during the post-treatment surveillance period, averaging 2.8 tests per patient. An additional 17% of patients received advanced imaging, averaging 1.5 images per patient.
Authors of the study noted that costs per patients undergoing tumor-marking tests and advanced images were significantly higher than the mean costs ($18,403 per patient) during the surveillance period.
After finding that oncologists (91%) and primary care providers (83%) were the most common physician specialties visited during early surveillance, authors concluded that targeting oncologists to improve appropriate tumor-marker testing could have positively impact the aligning of practice with the Choosing Wisely recommendations. Furthermore, targeting oncologists could help reduce the financial burden on patients.
“We believe one of the best ways we can help patients reduce their financial burden is for us to reinforce the message with oncologists that these tests have been shown to provide no benefit for this particular group of patients,” said Dr Lyman in an interview (May 25, 2017).—Zachary Bessette
