Variation in the Types of Providers Participating in Breast Cancer Follow-Up Care: A SEER-Medicare Analysis

Heather B. Neuman, Jessica R. Schumacher, David F. Schneider, Emily R. Winslow, Rebecca A. Busch, Jennifer L. Tucholka, Maureen A. Smith, Caprice C. Greenberg

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The current guidelines do not delineate the types of providers that should participate in early breast cancer follow-up care (within 3 years after completion of treatment). This study aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors and to identify factors associated with receipt of follow-up care from different types of providers. Methods: Stages 1–3 breast cancer survivors treated from 2000 to 2007 were identified in the Surveillance, Epidemiology and End results Medicare database (n = 44,306). Oncologist (including medical, radiation, and surgical) follow-up and primary care visits were defined using Medicare specialty provider codes and linked American Medical Association (AMA) Masterfile. The types of providers involved in follow-up care were summarized. Stepped regression models identified factors associated with receipt of medical oncology follow-up care and factors associated with receipt of medical oncology care alone versus combination oncology follow-up care. Results: Oncology follow-up care was provided for 80 % of the patients: 80 % with a medical oncologist, 46 % with a surgeon, and 39 % with a radiation oncologist after radiation treatment. The patients with larger tumor size, positive axillary nodes, estrogen receptor (ER)-positive status, and chemotherapy treatment were more likely to have medical oncology follow-up care than older patients with higher Charlson comorbidity scores who were not receiving axillary care. The only factor associated with increased likelihood of follow-up care with a combination of oncology providers was regular primary care visits (>2 visits/year). Conclusions: Substantial variation exists in the types of providers that participate in breast cancer follow-up care. Improved guidance for the types of providers involved and delineation of providers’ responsibilities during follow-up care could lead to improved efficiency and quality of care.

Original languageEnglish (US)
Pages (from-to)683-691
Number of pages9
JournalAnnals of surgical oncology
Issue number3
StatePublished - Mar 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology


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