Geographic variation in surveillance strategies following surgery for upper aerodigestive tract cancer

Abstract

5585 Background: The optimal method of follow-up for patients with upper aerodigestive tract carcinoma (UADT) after curative-intent primary treatment is unknown. There is evidence that the intensity of surveillance varies substantially among clinicians. Analysis of geographic variation in utilization of medical resources is often used to identify regions of over- or under-utilization. Methods: We surveyed the membership of the American Head and Neck Society regarding their recommended frequency of office visits and 13 surveillance tests (chest x-ray, head-neck CT, chest CT, head-neck MRI, head-neck sonogram, bone scan, CBC, liver function tests, thyroid function tests, serum electrolyte levels, tumor markers, esophagoscopy, and bronchoscopy) for their patients after potentially curative therapy for UADT cancers. Results: Of the 1,322 members surveyed, 610 (46%) responded, of which 420 (32%) were evaluable. Pooled responses from nine U.S. census regions, 12 metropolitan statistical areas (MSAs), and overseas members (16% of evaluable responses) were compared. There were statistically significant variations in practice patterns among census regions for office visits, CBC, head-neck CT, sonography, and esophagoscopy (p<0.05, ANOVA). The mean frequency of office visits also differed significantly (p<0.05) among MSAs, ranging from six in Houston to nine elsewhere during year 1 for patients with stage I lesions. Non-U.S. members use significantly more blood tests, imaging studies, and endoscopy for routine cancer surveillance than U.S. members (p<0.05). Surprisingly, the penetration rate of managed care organizations had no significant effect on post-treatment surveillance intensity. Conclusions: This analysis indicates that only a small portion of the wide variation in observed follow-up practice patterns can be explained by geographic determinants. No significant financial relationships to disclose.