Risk Management and Healthcare Policy (May 2022)
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
Massimo Gion,1 Giulia Cardinali,2 Stefano Guzzinati,3 Paolo Morandi,4 Chiara Trevisiol,5 Aline SC Fabricio,5 Massimo Rugge,3,6 Manuel Zorzi3 1Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy; 2Management Control Unit, Azienda ULSS 3 Serenissima, Venice, Italy; 3Veneto Tumour Registry, Azienda Zero, Padua, Italy; 4Medical Oncology Unit, Azienda ULSS 3 Serenissima, Venice, Italy; 5Veneto Institute of Oncology IOV - IRCCS, Padua, Italy; 6University of Padova, Department of Medicine DIMED, Padua, ItalyCorrespondence: Massimo Gion, Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Ospedale SS. Giovanni e Paolo – Castello, Venezia, 6777 – 30122, Italy, Tel +39 041 5294260, Fax +39 041 5295603, Email [email protected]: 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.Keywords: tumour markers, imaging exams, adherence to guidelines, routinely collected health data
