This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Johnson, F. E. Articles by Virgo, K. S. Search for Related Content PubMed PubMed Citation Articles by Johnson, F. E. Articles by Virgo, K. S.

Geographical Variation in Surveillance Strategies After Curative-Intent Surgery for Upper Aerodigestive Tract Cancer

¹ Surgical Service, Veterans Affairs Medical Center, 915 North Grand Boulevard, St. Louis, Missouri 63106
² Department of Surgery, Saint Louis University, St. Louis, Missouri
³ Department of Otolaryngology, Washington University, St. Louis, Missouri

Correspondence: Address correspondence and reprint requests to: Frank E. Johnson, MD, Saint Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, USA; E-mail: frank.johnson{at}med.va.gov.

Background: Analysis of geographical variation in utilization of medical resources is often used to identify regions of overutilization or underutilization.

Methods: We surveyed the membership of the American Head and Neck Society regarding their recommended frequency of office visits and 13 imaging studies and blood tests for their patients after potentially curative therapy for upper aerodigestive tract cancers.

Results: Of the 1322 members surveyed, 610 (46%) responded: 420 responses (32%) were assessable. Responses were compared by US Census Region, Metropolitan Statistical Area, and managed care organization penetration rate. Overseas members (16% of assessable responses) comprised a separate category for the regional analysis. There were statistically significant variations in practice patterns among Census Regions for office visits, complete blood count, computed tomography of the head, sonography, and esophagoscopy. Non-US members recommended significantly more blood tests, imaging studies, and endoscopy than US members for routine cancer surveillance. Only the frequency of office visits differed significantly among Metropolitan Statistical Areas. Surprisingly, the penetration rate of managed care organizations had no significant effect on posttreatment 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 geographical determinants.

Key Words: Follow-up • Head and neck cancer • Geographical variation • Small-area analysis