Data collection
tumor, Cancer
TUMOR, BREAST CANCER, PROSTATE, ONCOLOGY, CANCER
For each patient, we collated the laboratory and imaging tests performed during the 18 months after SCP receipt that were predetermined in the study protocol as “not recommended surveillance” (Table Surveillance testing recommendations for Stages I–III Cancer predetermined for the study protocolEvery 3–6 months: CEAAnnually: CT chest/abdomen/pelvisColonoscopy (can be done at year 3 if preoperative full colonoscopy normal)ImagingBreast MRIPET/CTCT chest/abdomen/pelvisLiver ultrasoundBone scanBlood testsTumor markersImagingChest x‐rayPET/CTImagingPET/CTBone scanAbbreviations: CEA, carcinoembryonic antigen; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography scans; PSA, prostate specific antigen.Adapted from 2013 National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines.Consort diagramInitially, one research team member abstracted the laboratory/imaging testing from the medical record, and a second research team member reviewed the abstraction. Subsequently, two physicians (one general internist, one medical oncologist) reviewed the abstracted ordering provider's documentation in the medical record for tests ordered outside SCP recommendations. Tests determined to have been ordered for non‐cancer ‐related work were excluded. If a test was not advised under any circumstance for surveillance from national guidelines (e.g., tumor markers in breast cancer), it was designated as consistent with overuse. In instances when it was unclear why testing was ordered from the information abstracted by research staff members, a medical oncologist performed additional chart review to adjudicate whether the test was consistent with overuse. A second physician reviewer who was blinded to the first reviewer's assessments separately adjudicated 10% of the tests to ensure agreement. Of the six tests reviewed, there was concordance on five of the tests, and agreement on the remaining test after additional discussion so we proceeded with single adjudication,The updated American College of Radiology recommendations mentions use of breast MRI for women with a personal history of breast cancer, either dense tissue or who were diagnosed before the age of 50.