Use of Routine Health Datasets to Assess the Appropriateness of Diagnostic Tests in the Follow-Up of Breast Cancer Patients: A Population-Based Study on 3930 Patients

Abstract

Purpose Clinical practice guidelines (CPGs) recommend against intensive follow-up in asymptomatic women with breast cancer (BC). The present study assessed the adherence to CPGs of diagnostic tests ordering during BC follow-up by exploring routinely collected health data through an algorithm developed to distinguish patients according to their status at follow-up. Patients and Methods A retrospective population-based cohort study was performed monitoring the diagnostic tests ordered during 5 years of follow-up in all BC cases incident in 2013 in the Veneto Region, Italy. Data were extracted from the Veneto Tumour Registry, the Hospital Discharge Records and the Outpatients’ Records of Diagnostic and Therapeutic Procedures. The algorithm was developed using information on infusion of anticancer agents, imaging exams ordered, and death. Results The algorithm classified patients by status at follow-up in four groups: (i) probably no-evidence-of-disease (NED), (ii) suspicious signs of relapse not confirmed, (iii) increased risk of relapse and (iv) advanced disease at presentation or progressive disease. A total of 3930 consecutive incident cases were followed-up for 5 years, corresponding to 17,184 person-years, 15,345 of which pertaining to NED cases. In NED cases, 32,900 tumour markers and 15,858 imaging exams were ordered. Liver ultrasonography and chest radiography were most frequently ordered. Conclusion In contrast with recommendations of CPGs, a substantial overordering of tumour markers and imaging exams occurred in NED BC patients. The developed algorithm can be repeatedly applied to routine health datasets for regular monitoring of the adherence to CPGs and of the impact of interventions to improve appropriateness.

Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records

“…[9][10][11] In the case of CA15.3 the O/P ratio of 1.0 suggests a possible regular yearly use of the marker during the follow up of breast cancer, since women without evidence of disease represent the majority of prevalent cases. 25 In the case of CA-125 for ovarian or uterine malignancies and PSA for prostate cancer, the O/P ratios of 2.1 and 2.7, respectively, may be conceivable with a higher number of patients under systemic treatment for advanced (i.e., ovarian cancer) or unresectable (i.e., prostate cancer) disease. Conversely, the 21.7 O/P ratio of CA19.9 and 14.3 O/P ratio of AFP cannot be justified by the prevalence of the target malignancies of the markers, and they are almost certainly used to inappropriately monitor malignancies other than those indicated by CPGs.…”