{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T09:16:28Z","timestamp":1785316588205,"version":"3.55.0"},"reference-count":35,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"24","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2016,8,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> The optimal frequency of monitoring patients with metastatic breast cancer (MBC) is unknown; however, data suggest that intensive monitoring does not improve outcomes. We performed a population-based analysis to evaluate patterns and predictors of extreme use of disease-monitoring tests (serum tumor markers [STMs] and radiographic imaging) among women with MBC. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> The SEER-Medicare database was used to identify women with MBC diagnosed from 2002 to 2011 who underwent disease monitoring. Billing dates of STMs (carcinoembryonic antigen and\/or cancer antigen 15-3\/cancer antigen 27.29) and imaging tests (computed tomography and\/or positron emission tomography) were recorded; if more than one STM or imaging test were completed on the same day, they were counted once. We defined extreme use as &gt; 12 STM and\/or more than four radiographic imaging tests in a 12-month period. Multivariable analysis was used to identify factors associated with extreme use. In extreme users, total health care costs and end-of-life health care utilization were compared with the rest of the study population. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> We identified 2,460 eligible patients. Of these, 924 (37.6%) were extreme users of disease-monitoring tests. Factors significantly associated with extreme use were hormone receptor\u2013negative MBC (odds ratio [OR], 1.63; 95% CI, 1.27 to 2.08), history of a positron emission tomography scan (OR, 2.92; 95% CI, 2.40 to 3.55), and more frequent oncology office visits (OR, 3.14; 95% CI, 2.49 to 3.96). Medical costs per year were 59.2% higher in extreme users. Extreme users were more likely to use emergency department and hospice services at the end of life. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Despite an unknown clinical benefit, approximately one third of elderly women with MBC were extreme users of disease-monitoring tests. Higher use of disease-monitoring tests was associated with higher total health care costs. Efforts to understand the optimal frequency of monitoring are needed to inform clinical practice. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2016.66.6313","type":"journal-article","created":{"date-parts":[[2016,5,10]],"date-time":"2016-05-10T04:24:36Z","timestamp":1462854276000},"page":"2820-2826","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":28,"title":["Use and Costs of Disease Monitoring in Women With Metastatic Breast Cancer"],"prefix":"10.1200","volume":"34","author":[{"given":"Melissa K.","family":"Accordino","sequence":"first","affiliation":[{"name":"Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. Hu, Weill Cornell Medicine, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. Hu, Weill Cornell Medicine, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmya","family":"Vasan","sequence":"additional","affiliation":[{"name":"Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. Hu, Weill Cornell Medicine, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred I.","family":"Neugut","sequence":"additional","affiliation":[{"name":"Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. Hu, Weill Cornell Medicine, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace C.","family":"Hillyer","sequence":"additional","affiliation":[{"name":"Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. 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