TY - JOUR
T1 - Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers
AU - Yao, Christopher M.K.L.
AU - Fu, Shuangshuang
AU - Tam, Samantha
AU - Kiong, Kimberley L.
AU - Guo, Theresa
AU - Zhao, Hui
AU - Giordano, Sharon H.
AU - Sturgis, Erich M.
AU - Lewis, Carol M.
N1 - Funding Information:
This research was supported in part by the Cancer Prevention and Research Institute of Texas (grant RP160674) and Komen (SAC150061 to Sharon H. Giordano) and by National Cancer Institute Cancer Center Support Grant CA016672.
Publisher Copyright:
© 2021 American Cancer Society
PY - 2021/5/15
Y1 - 2021/5/15
N2 - Background: Guidelines for follow-up after head and neck cancer (HNC) treatment recommend frequent clinical examinations and surveillance testing. Here, the authors describe real-world follow-up care for HNC survivors and variations in surveillance testing. Methods: Using Surveillance, Epidemiology, and End Results (SEER)–Medicare data, this study examined a population-based cohort of HNC survivors between 2001 and 2011 Usage of cross-sectional head and neck imaging (CHNI), chest imaging (CI), positron emission tomography (PET), fiberoptic nasopharyngolaryngoscopy (FNPL), and, in irradiated patients, thyroid function testing (TFT) was captured over 2 consecutive surveillance years. Multivariate modeling with logistic regression analyses was used to assess variations by clinical factors, nonclinical factors, number and types of providers seen and their evolution over time. Results: Among 13,836 HNC survivors, the majority saw a medical, radiation, or surgical oncologist and a primary care provider (PCP; 81.7%) in their first year of surveillance. However, only 58.1% underwent either PET or CHNI, 47.8% underwent CHNI, 64.1% underwent CI, 32.5% underwent PET scans, 55.0% underwent FNPL, and 55.9% underwent TFT. In multivariate analyses, patients who followed up with more providers and those who followed up with both a PCP and an oncologist were more likely to undergo surveillance testing (P <.007). However, adjusting for providers seen did not explain the variations in surveillance testing rates based on age, race, education, income level, and place of residence. Over time, there was a gradual increase in the use of PET scans and TFT during surveillance years. Conclusions: In this large SEER-Medicare data study, only half of HNC survivors received the recommended testing, and greater compliance was seen in those who followed up with both an oncologist and a PCP. More attention is needed to minimize variations in surveillance testing across sociodemographic groups.
AB - Background: Guidelines for follow-up after head and neck cancer (HNC) treatment recommend frequent clinical examinations and surveillance testing. Here, the authors describe real-world follow-up care for HNC survivors and variations in surveillance testing. Methods: Using Surveillance, Epidemiology, and End Results (SEER)–Medicare data, this study examined a population-based cohort of HNC survivors between 2001 and 2011 Usage of cross-sectional head and neck imaging (CHNI), chest imaging (CI), positron emission tomography (PET), fiberoptic nasopharyngolaryngoscopy (FNPL), and, in irradiated patients, thyroid function testing (TFT) was captured over 2 consecutive surveillance years. Multivariate modeling with logistic regression analyses was used to assess variations by clinical factors, nonclinical factors, number and types of providers seen and their evolution over time. Results: Among 13,836 HNC survivors, the majority saw a medical, radiation, or surgical oncologist and a primary care provider (PCP; 81.7%) in their first year of surveillance. However, only 58.1% underwent either PET or CHNI, 47.8% underwent CHNI, 64.1% underwent CI, 32.5% underwent PET scans, 55.0% underwent FNPL, and 55.9% underwent TFT. In multivariate analyses, patients who followed up with more providers and those who followed up with both a PCP and an oncologist were more likely to undergo surveillance testing (P <.007). However, adjusting for providers seen did not explain the variations in surveillance testing rates based on age, race, education, income level, and place of residence. Over time, there was a gradual increase in the use of PET scans and TFT during surveillance years. Conclusions: In this large SEER-Medicare data study, only half of HNC survivors received the recommended testing, and greater compliance was seen in those who followed up with both an oncologist and a PCP. More attention is needed to minimize variations in surveillance testing across sociodemographic groups.
KW - follow-up
KW - head and neck cancer
KW - provider type
KW - surveillance testing
KW - survivorship
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U2 - 10.1002/cncr.33402
DO - 10.1002/cncr.33402
M3 - Article
C2 - 33471396
AN - SCOPUS:85100120793
SN - 0008-543X
VL - 127
SP - 1699
EP - 1711
JO - Cancer
JF - Cancer
IS - 10
ER -