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Patterns of Care in Early-Stage Breast Cancer Survivors in the First Year After Cessation of Active Treatment

From the Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Control Program, and Department of Psychiatry, Georgetown University Medical Center, Washington, DC; Agency for Healthcare Research and Quality, Rockville, MD; and Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Department of Psychology; and Schools of Medicine and Public Health, University of California, Los Angeles, Los Angeles, CA

Address reprint requests to Jeanne Mandelblatt, MD, MPH, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Blvd, Ste 4100, Washington, DC 20057; e-mail: mandelbj{at}georgetown.edu

PURPOSE: Patterns of health care use have not been well described for breast cancer survivors. The purpose of this study was to describe the health service use in a survivor cohort.

PATIENTS AND METHODS: Women with stage I or II breast cancer were recruited (n = 558) after primary treatment for a multicenter, randomized trial of psychoeducational interventions for facilitating transition to survivorship; 418 women completed the study. Participants completed calendar diaries detailing health care use for 1 year after treatment. Services were coded using Current Procedural Terminology–Fourth Edition codes; costs were estimated using year 2000 Medicare reimbursements.

RESULTS: Health care use diary data were available for 391 women (70% of the sample). On average, these survivors reported 30 episodes of health service use in the year after treatment. Total annual costs of care averaged more than $1,800 per survivor; medical office visits were the major component of costs. Type of cancer treatment, depression, and physical function and comorbid illness were independent predictors of the costs of services. There were geographic variations in initial local treatment patterns and in post-treatment costs. Notably, all women should have received surveillance mammography in the time period, but only 61.9% did so; the odds of mammogram receipt were higher for women who had a lumpectomy (v mastectomy) and women who were white (v nonwhite).

CONCLUSION: Use of health services is frequent and intensive in the first year after treatment for breast cancer. Despite frequent contact with the health care system, there is room for improvement in providing guideline-suggested surveillance mammography for survivors.

Supported by Grants No. R01-CA63028 and K05-CA96940 (J.S.M.) from the National Cancer Institute, Bethesda, MD. P.A.G. is also funded by an American Cancer Society Clinical Research Professorship.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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