"Room for improvement" in care after breast cancer

Survivors of early-stage breast cancer generally receive good health care in the first year after they finish treatment, but not all of them get the recommended check-up mammogram, according to a new report.

Among every 100,000 women alive today in the United States, 815 are breast cancer survivors. Monitoring after treatment is important for detection of a second cancer, reassurance that the cancer remains in remission, and identification of side effects from the cancer treatment.

Dr. Jeanne S. Mandelblatt of the Lombardi Comprehensive Cancer Center in Washington, DC, and her colleagues studied a group of survivors with stage I or II breast cancer who had received primary treatment. The patients were asked to complete calendar diaries detailing health care use for one year after treatment.

Of the 558 women recruited, 391 provided a health care diary. The researchers found that, on average, these survivors used health service 30 times in the year after treatment, a rate higher than that of the general population. The total annual costs of care averaged more than $1,800 per patient, with medical office visits being the major component of costs.

While there were geographic variations in initial treatment patterns and in post-treatment costs, the team found that higher use, and cost, of care was predicted by the type of cancer treatment, the presence of depression, and the overall physical function of the patients, as well as the presence of other illness.

Although all women should have a mammography in the first year after treatment, the researchers report that only 62 percent did so. Women who had a lumpectomy were more likely to receive a mammogram than those who had a mastectomy, and white women were more likely to receive one than nonwhite women.

According to the authors, the use of health care resources is high in the year after diagnosis and treatment, and there is "room for improvement in the recommended use of surveillance mammography."

They conclude that "future research should focus on ensuring that breast cancer survivors obtain recommended post-treatment surveillance and management of post-treatment symptoms that may contribute to excess (health care) use."

SOURCE: Journal of Clinical Oncology, January 2006.