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Quality of Cancer Survivorship Care in the Military Health System (TRICARE)

Fox, Justin P. MD, MHS*; Jeffery, Diana D. PhD; Williams, Thomas V. PhD; Gross, Cary P. MD*‡

doi: 10.1097/PPO.0b013e3182821930
Original Articles
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Purpose Following the acute phase of treatment, national guidelines recommend cancer survivors have routine contact with health care providers and undergo basic ancillary testing while avoiding high-cost imaging (HCI). We conducted this study to determine how frequently breast, prostate, and colorectal cancer survivors received recommended follow-up care and HCI tests during the survivorship period.

Methods Using administrative data from TRICARE beneficiaries, we identified a cohort of patients who were treated for breast, prostate, or colorectal cancer between October 2005 and March 2007. These patients were then followed through September 2010. During the 3 years after initial treatment, we determined how frequently survivors received all minimum recommended survivorship care as defined by national guidelines and underwent HCI tests and if these outcomes varied by geographic region.

Results Overall, 3148 patients underwent treatment for breast (n = 1630), prostate (n = 1173), or colorectal (n = 345) cancer. Sixty-five percent received all minimum recommended care over 3 years (breast = 74.1%, prostate = 65.3%, colorectal = 25.5%). During the 3-year period, 74.1% of breast cancer survivors received a mammogram each year, whereas 69.1% of colorectal cancer survivors had at least 1 colonoscopy. Sixty-four percent had at least 1 HCI study during the 3-year period (positron emission tomography = 10.9%, computer tomography = 48.8%, magnetic resonance imaging = 36.6%) at a cost of $3.5 million. Substantial state-level variation was noted for both outcomes.

Discussion Some cancer survivors do not receive recommended care following initial treatment while frequently undergoing HCI. The existing geographic variation in quality and imaging utilization suggests that improvements to cancer survivorship care are possible.

From the *Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT; †TRICARE Management Activity, Center for Healthcare Management Studies Defense Health Cost Assessment and Program Evaluation, Falls Church, VA; ‡Cancer Outcomes Policy and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale School of Medicine, New Haven, CT.

Drs Fox and Gross are involved with the Clinical Scholar’s Program, which is supported by the Robert Wood Johnson Foundation.

This work has not previously been presented or published in any format.

The views expressed in this article are those of the authors and do not reflect the official policy of the US Air Force, Department of Defense, or the US Government.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Reprints: Cary P. Gross, MD, PO Box 208056, 333 Cedar St, New Haven, CT 06520. E-mail: cary.gross@yale.edu.

© 2013 Lippincott Williams & Wilkins, Inc.