Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario

Brennan, Kelly; Hall, Stephen F.; Owen, Timothy; Griffiths, Rebecca; Peng, Yingwei

doi:10.3747/co.25.3892

Cited by 15 publications

(20 citation statements)

References 34 publications

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“…Decision making in follow‐up care would be reduced in complexity if there were higher level evidence available on the subject, rather than consensus‐based guidelines developed outside of Canada. The results of this study, a description of HNC patients’ well‐being and needs in routine follow‐up as well as our research team's recent efforts to outline current practices in the real‐world (Brennan, Hall, Owen, Griffiths, & Peng, ) aid in laying the ground work necessary to plan a future Canadian trial.…”

Section: Discussionmentioning

confidence: 98%

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Routine follow-up care after curative treatment of head and neck cancer: A survey of patients’ needs and preferences for healthcare services

et al. 2019

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Objective The experience of a cancer diagnosis and receiving treatment can have profound impacts on health and subsequently patients may require significant support. Often, these needs are not identified or addressed. Given that less is known about the follow‐up requirements for head and neck cancer patients, this study aimed to describe their follow‐up needs and preferences. Methods In Ontario, Canada from 2012–2014, 175 patients completed a questionnaire at an appointment one year after treatment. To identify associations between characteristics and follow‐up needs, bivariate analyses and ordinal logistic regression models were employed. Results A diversity of follow‐up requirements was found. The most commonly reported follow‐up needs were having imaging tests performed (66%), receiving information on treatment side effects (84%) and prognosis details (95%). Many patients experienced an improvement in their health (79%) but notably, not all. Characteristics such as psychosocial and well‐being measures (functional status, anxiety, fear of recurrence, quality of life), attitudes towards follow‐up (reassurance, communication), demographics (age, sex, marital status), and stage of disease predicted needs and preferences for follow‐up care (p < 0.05). Conclusion While awaiting top‐level evidence, this work demonstrates the variation in needs and supports the identification of patients with higher follow‐up requirements by screening for well‐being and enquiring about expectations in follow‐up care.

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Section: Discussionmentioning

confidence: 98%

“…well-being and needs in routine follow-up as well as our research team's recent efforts to outline current practices in the real-world (Brennan, Hall, Owen, Griffiths, & Peng, 2018) aid in laying the ground work necessary to plan a future Canadian trial.…”

Section: Con Clus I On and Future Workmentioning

confidence: 99%

Routine follow-up care after curative treatment of head and neck cancer: A survey of patients’ needs and preferences for healthcare services

et al. 2019

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“…"When there is no evidence, practice will vary" 20 . In a previously reported study based on 3675 patients, we assessed the variation in hnc follow-up in Ontario 21 . We found marked variation in all aspects of follow-up (including frequency of appointments), without substantial relationship to guidelines.…”

Section: Introductionmentioning

confidence: 99%

Does the Frequency of Routine Follow-Up after Curative Treatment for Head-and-Neck Cancer Affect Survival?

et al. 2019

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Background: Routine follow-up is a cornerstone of oncology practice but evidence is lacking to support most aspects. Our Objective was to investigate the relationship between frequency of routine follow-up and survival.Methods: A population-based study using electronic health-care data based on 5310 patients from Ontario diagnosed with squamous cell head and neck cancer between 2007 and 2012. Treatments included surgery (24.6%), radiotherapy +/- chemotherapy (52.4%) and combined surgery and radiotherapy (23%). We determined the follow-up oncologist for each patient, calculated the average follow-up visits over 2.5 years for all the patients of each oncologist and compared by treatment the overall survival of the patients for the high, medium and low follow-up oncologist groups using Kaplan Meier and multiple variable regression analysis. Results: Many oncologists saw patients 40 to 80% more often than others. There was no relationship between appointment frequency and survival for patients for any treatment group.Conclusion: The practice of routine follow-up varies and is costly to both a health care system and to patients. Without evidence on the effectiveness of our current policies further research is required to investigate new or optimal practices.

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“…A study analyzing surveillance testing in Canada found similar variations, with male sex, surgery as treatment, and lower income quintiles associated with fewer than recommended follow-up visits. 26 Although the socioeconomic status, income, and education level were extrapolated from place of residence in our study and were only moderately reflective of an individual's socioeconomic status, it is worth emphasizing the importance of understanding survivorship needs across cultures and socioeconomic status as we strive toward equitable, high-quality cancer survivorship care. 27 Recent guidelines have also described the role of PCPs in HNC survivorship; the comprehensiveness of their role coupled with a lack of expertise in these domains may underscore practical challenges that have not been fully explored.…”

Section: Discussionmentioning

confidence: 99%

Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers

Yao

Tam

et al. 2021

Cancer

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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.

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Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario

Abstract: BackgroundThe actual practices of routine follow-up after curative treatment for head-and-neck cancer are

Cited by 15 publications

References 34 publications

Routine follow-up care after curative treatment of head and neck cancer: A survey of patients’ needs and preferences for healthcare services

Routine follow-up care after curative treatment of head and neck cancer: A survey of patients’ needs and preferences for healthcare services

Does the Frequency of Routine Follow-Up after Curative Treatment for Head-and-Neck Cancer Affect Survival?

Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers

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