INTRODUCTION:In 2021, the Commission on Cancer implemented Standard 5.8, which requires that lymph nodes be sampled from ≥1 hilar and ≥3 different mediastinal lymph node stations for all curative-intent lung cancer resections. While 80% compliance is expected of all Commission on Cancer-accredited hospitals, recent data illustrates only half of sites are currently meeting criteria. We evaluated perceived barriers and facilitators in implementing Standard 5.8. METHODS:In this multicenter qualitative study, 20 semistructured interviews were conducted across academic and community-based institutions. We interviewed key stakeholders, including thoracic surgeons, pathologists, operating room staff, a cancer liaison physician, and clinical data analysts. Thematic analysis was facilitated by the tailored implementation for chronic disease checklist. RESULTS:Themes were mapped to six tailored implementation for chronic disease domains. Most participants felt the guideline was not burdensome and did not alter their clinical practices. Although many agreed that a minimum threshold for lymph node evaluation should exist, some participants were uncertain of the supporting evidence and identified potential technical and clinical barriers to implementation. Interdisciplinary collaboration was a key facilitator to compliance, as well as alignment with professional society guidelines. Higher compliance rates were thought to be driven by increased monitoring and performance feedback, in addition to departmental leadership and support. CONCLUSIONS:Mixed opinions regarding Standard 5.8 align with currently low national compliance rates. Participants emphasized the need for additional evidence to support the standard, underscoring the importance of future prospective studies. Support for strong interdisciplinary communication, regularly scheduled feedback, endorsement by cardiothoracic societies and departmental leadership may improve compliance.

A peri-acetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage/labral pathologies are very commonly present and there is a lack of evidence examining the benefits of the adjunct arthroscopy to these. The goal of this study is to compare the outcomes of patients undergoing PAO with and without arthroscopy. A prospective, randomized controlled multi-center trial including 203 patients with symptomatic hip dysplasia was conducted. 99 patients with hip dysplasia were randomized to receive an isolated PAO [mean age 27 years (16-44); Mean BMI of 25.1 (18.3-37.2); 83% females] and 104 patients underwent concomitant PAO with an arthroscopy [mean age 27 years (16-49); Mean BMI of 25.1 (17.5-25.1); 88% females]. Clinical outcomes were assessed pre-operatively, at 6 months, 12 months, and 24 months post-surgery, using the international Hip Outcome Tool-33 (iHOT-33), Hip Disability and Osteoarthritis Outcome (HOOS), and the (PROMIS) score. Revision and Reoperation were also recorded. There were no significant differences between the patients receiving a PAO plus arthroscopy and the patients receiving PAO alone 6-, 12-, and 24 months, post-surgery. The mean (SD) Pre-operative PROMIS score was [32.3 (SD 7.1) vs. 34.1(SD 5.8)] and 24 months post-operative was [38.7 (SD 6.3) vs. 38.5 (SD 7.0)]. Pre-operative iHot-33 score was [31.2 (SD 16.0) vs. 36.4 (SD 15.9)] and 24 months post-operative was [78.5 (SD 22.7) vs. 77.1 (SD 20.9)]. Pre-operative HOOS score was [49.9 (SD 16.9) vs. 54.2 (SD 16.9)] and 24 months post-operative was [86.8 (SD 14.1) vs. 83.3 (SD 16.0)]. 27 patients from the PAO plus arthroscopy and 28 without had reoperation for events including hardware removal, unresolved pain, and superficial wound infection. 4 patients having PAO without arthroscopy necessitated an arthroscopy later to resolve persistent symptoms and 1 patient from the PAO plus arthroscopy necessitated an additional arthroscopy. The results demonstrated an improvement in outcomes and quality of life for both groups with no significant differences in the postoperative outcomes of patients receiving PAO with and without an arthroscopy.

The purpose of this study was to assess the rate and pattern of intraarticular extension of ballistic distal femur fractures. The authors examined all ballistic distal femur fractures that presented to their hospital between 2015 and 2019. The authors excluded direct condylar injuries and patients of whom a computed tomography (CT) scan was not obtained. The authors classified the rate of intraarticular extension and the pattern of that extension. Sixty-three fractures met inclusion in this study. Of these, 19 (30%) extended intraarticular, whereas the remaining 44 did not. Ninety-five percent of the fractures in the intraarticular group contained a sagittal fracture, whereas only 26% contained a fracture in the coronal plane. Ballistic distal femur fractures have a lower rate of intraarticular extension than blunt fractures. There are predictable patterns of joint involvement with ballistic injuries that warrant different treatment strategies. The authors propose a new classification system to further classify these unique fractures. (Journal of Surgical Orthopaedic Advances 33(3):178-180, 2024).

ABSTRACT This study aims to examine the trends and demographics of periacetabular osteotomy (PAO) in the United States from 2016 to 2020 using a large healthcare database analysis. The PearlDiver database was queried for patients who underwent a PAO procedure starting with current procedural terminology (CPT) codes 27299, S2115 and 27146. Subsequently, the population was filtered for patients being ages 12–50, having an inpatient charge-type and those having a length of stay of at least 1 day. Patients with total hip arthroplasty were filtered out, and the resulting population was filtered by ICD-10 diagnosis codes. The providers of each patient were also examined to ensure their history of treating hip dysplasia. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P < 0.05 reported as significant). A total of 535 consecutive patients were analyzed over the study period. There was a higher incidence of PAO in females compared with males (P < 0.001) and a higher incidence of PAO in patients aged 15–19 years compared with older age groups (P = 0.017). Within the first year after the index PAO, 171 of the 535 patients, almost one-third (32%), received a reoperation. Of the 171 reoperations, 115 were deep removal of implant, 55 were a hip arthroscopy and 1 patient had a bone excision for heterotopic ossification. Similar studies should be carried out using other large health databases to confirm the external validity of these trends and rates across the United States.

A peri-acetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage/labral pathologies are very commonly present and there is a lack of evidence examining the benefits of the adjunct arthroscopy to treat these. The goal of this study is to compare the clinical outcome of patients undergoing PAO with and without arthroscopy with primary end-point being the International Hip Outcome Tool-33 (iHOT-33) at one year. In a multi-center study, two hundred and three patients with symptomatic hip dysplasia were randomized: 97 patients undergoing an isolated PAO (mean age 27 years (16-44); mean BMI of 25.1 (18.3-37.2); 86% females) and 91 patients undergoing PAO with an arthroscopy [mean age 27 years (16-49); Mean BMI of 25.1 (17.5-25.1); 90% females]. At a mean follow up of 2.3 years (range 1-5 years), all patients exhibited significant improvements in their functional score with no significant differences between PAO plus arthroscopy versus PAO alone at 12 months post-surgery on all scores: pre-op iHot-33 score 31.2 (SD 16.0) vs. 36.4 (SD 15.9) and 12 months post-operative was 72.4 (SD 23.4) vs. 73.7 (SD 22.6)]. Pre-operative HOOS-pain score was [60.3 (SD 19.6) vs. 66.1 (SD 20.0)] and 12 months post-operative was [88.2 (SD 15.8) vs. 88.4 (SD 18.3)]. Mean Pre-operative Physical Health PROMIS score was [42.5 (SD 8.0) vs. 44.2 (SD 8.8)] and 12 months post-operative was [48.7 (SD 8.5) vs. 52.0 (SD 10.6)]. Four patients having PAO without arthroscopy necessitated an arthroscopy later to resolve persistent symptoms and 1 patient from the PAO plus arthroscopy necessitated an additional arthroscopy. This RCT has failed to show any significant clinical benefit in performing hip arthroscopy at the time of the PAO at one-year followup. Longer follow up will be required to determine if hip arthroscopy provides added value to a PAO for symptomatic hip dysplasia.

With hip arthroscopy cases, there has been a concomitant increase in complications and the need for revision surgery. This study aims to further contribute to the literature regarding hip arthroscopy failure rates and associated patient factors following an index hip arthroscopy procedure. The PearlDiver database was queried for patients who had undergone hip arthroscopy. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to ensure that follow-up was performed on the ipsilateral limb. Hip arthroscopy failure was defined specifically as subsequent ipsilateral total hip arthroplasty (THA) and reoperation, which were examined in all patients that met inclusion criteria. Independent patient variables, including psychiatric comorbidities, preoperative SSRI use, smoking, and obesity, were examined to identify an association with failure rates. A Student t-test, with a significance set at P < 0.05, was used for statistical comparisons of postoperative outcomes. Odds ratios were used to calculate the probability of short-term hip reoperation in patients with the above independent variables. A total of 19 067 hip arthroscopy patients were included in this study. Within 2 years from the index hip arthroscopy, there was an 11.42% failure rate as defined by subsequent reoperation and 7.16% failure rate as defined by revision to THA, with a total revision surgery rate of 18.58%. The most common reoperation procedure was revision femoroplasty (72%). Patients with an active diagnosis of a psychiatric comorbidity in the year leading up to a hip arthroscopy procedure were 1.74 times more likely to require a hip reoperation within 1 year (95% CI, 1.55-1.95).

Background:Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns. Methods:We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge. Our goal was to report current surgical pain management strategies, adjunct medications, type of anesthesia, deep venous thrombosis and heterotopic ossification prophylaxis strategies, initiation of physical therapy, and use of continuous passive motion (CPM). We reviewed current literature to identify studies supporting these perioperative strategies and identify knowledge gaps that would benefit from further investigation. Results:Of the 16 surgeons surveyed, 75% had been in practice greater than 10 years and most had not altered their post-operative protocol for more than 3 years. 15/16 surgeons felt that length of stay could be reduced at their institution with improved peri-operative pain management. 6/16 were considering or had already implemented outpatient PAO as a part of their practice. We found significant variability in the pain medications provided at all peri-operative stages. 14/16 utilized general anesthesia, and many utilized epidural or peripheral nerve blocks. 6/16 surgeons utilized surgical field block (also referred to as periarticular block). These surgeons advocated that surgical field block was an effective intervention with no/minimal complication risk. There is very little literature critically evaluating efficacy of these perioperative management strategies for PAO. Conclusion:There is significant practice variability in peri-operative management of PAO surgery. We report various strategies utilized by a group of experienced surgeons and review supporting literature. There are significant knowledge gaps in best surgical pain management strategies, adjunct medications, surgical field blocks, and use of CPM that need further investigation. Level of Evidence: IV.

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome. A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT). 74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI. Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair.

Acute pulmonary embolism (PE) is a frequently diagnosed condition. Prediction of in-hospital deterioration is challenging with current risk models. The Calgary Acute Pulmonary Embolism (CAPE) score was recently derived to predict in-hospital adverse PE outcomes but has not yet been externally validated. Retrospective cohort study of normotensive acute pulmonary embolism cases diagnosed in our emergency department between 2017 and 2019. An external validation of the CAPE score was performed in this population for prediction of in-hospital adverse outcomes and a secondary outcome of 30-day all-cause mortality. Performance of the simplified Pulmonary Embolism Severity Index (sPESI) and Bova score was also evaluated. 712 patients met inclusion and exclusion criteria, with 536 patients having a sPESI score of 1 or more. Among this population, the CAPE score had a weak discriminative power to predict in-hospital adverse outcomes, with a calculated c-statistic of 0.57. In this study population, an external validation study found weak discriminative power of the CAPE score to predict in-hospital adverse outcomes among normotensive PE patients. Further efforts are needed to define risk assessment models that can identify normotensive PE patients at risk for in hospital deterioration. Identification of such patients will better guide intensive care utilization and invasive procedural management of PE.

Heterotopic ossification (HO) following acetabular fracture surgery is relatively common. The purpose of this study was to perform a systematic review of the literature regarding HO rates following acetabular surgery and the effectiveness of the various prophylactic measures taken to prevent its occurrence. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms ("Acetabular" OR "Acetabulum") AND ("Heterotopic Ossification" OR "HO" OR "Ectopic Ossification"). Inclusion criteria included articles published in English reporting on HO in acetabular fracture surgery. Descriptive statistics were calculated with categorical data presented as frequency with percentages and continuous data as means. Standard weighted means were calculated for all parameters. Sixty-six articles were included in this study with a total of 5,028 patients. HO was identified in 1,511 (30%) of fractures. Indomethacin (27%) and radiation therapy (24%) demonstrated decreased rates of HO formation versus no prophylaxis (36%). In particular, rates of severe HO formation were substantially decreased with radiation therapy (3%) and indomethacin (7%) compared to no prophylaxis (18%). Indomethacin and radiation therapy both appear to decrease HO formation and severity without substantially increasing surgical morbidity. (Journal of Surgical Orthopaedic Advances 32(4):217-224, 2023).

IMPORTANCE Most patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines recommending consideration of outpatient treatment for those with low risk stratification scores. One barrier to outpatient treatment may be clinician concern regarding findings on PE-protocol computed tomography (CTPE), which are perceived as high risk but not incorporated into commonly used risk stratification tools. OBJECTIVE To evaluate the association of concerning CTPE findings with outcomes and treatment of patients in the ED with acute, low-risk PE. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a registry of all acute PEs diagnosed in the adult ED of an academic medical center from October 10, 2016, to December 31, 2019. Acute PE cases were divided into high- and low-risk groups based on PE Severity Index (PESI) class alone or using a combination of PESI class and biomarker results. The low-risk groupwas further divided based on the presence of concerning CTPE findings: (1) bilateral central embolus, (2) right ventricle-to-left ventricle ratio greater than 1.0, (3) right ventricle enlargement, (4) septal abnormality, or (5) pulmonary infarction. Data analysis was conducted from June to October 2022. MAIN OUTCOMES AND MEASURES The primary outcomewas all-cause mortality at 7 and 30 days. Secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and/or bedside ultrasonography, and activation of the PE response team (PERT). RESULTS Of 817 patients (median [IQR] age, 58 [47-71] years; 417 (51.0%) female patients; 129 [15.8%] Black and 645 [78.9%] White patients) with acute PEs, 331 (40.5%) were low risk and 486 (59.5%) were high risk by PESI score. Clinical outcomes were similar for all low-risk patients, with no 30-day deaths in the low-risk group with concerning CTPE findings (0 of 151 patients) vs 4 of 180 (2.2%) in the low-risk group without concerning CTPE findings and 88 (18.1%) in the high-risk group (P <.001). Low-risk patients with concerning CTPE findings were less frequently discharged from the ED than those without concerning CTPE findings (3 [2.0%] vs 14 [7.8%]; P =.01) and had more frequent echocardiography (87 [57.6%] vs 49 [27.2%]; P <.001) and PERT activation for consideration of advanced therapies (34 [22.5%] vs 11 [6.1%]; P <.001). CONCLUSIONS AND RELEVANCE In this single-center study, CTPE findings widely believed to confer high risk were associated with increased hospitalization and resource utilization in patients with low-risk PE but not short-term adverse clinical outcomes.

Background: Pulmonary Embolism Response Teams (PERT) were employed at multiple institutions to bridge the gap between varied treatment options for acute PE and unclear evidence for optimal management. There is limited data regarding the impact of PERT on the use of advanced therapies and clinical outcomes.Methods: We performed a retrospective single-center cohort study comparing patients that presented to the ED with an acute PE before and after the creation of PERT in June 2017 at our institution. We assessed utilization of advanced therapies, LOS, and mortality.Results: A total of 817 patients (168 pre-PERT, 649 post-PERT) were evaluated in the ED with an acute PE be-tween October 2016 and December 2019. Both groups were similar in demographics, comorbidities, and PESI score. There was a decrease in advanced therapy use (16 % vs. 7.5 %, p = 0.006) after PERT creation. Most notable decreases were in catheter-based therapies (8.5 % vs. 2.2 %, p = 0.008) and IVC filter placement (5.3 % vs. 3.2 %, p < 0.001). Median ICU LOS (2.5 days vs. 2.3 days, p = 0.55) and hospital LOS (3.1 vs. 3.0, p = 0.92) did not vary pre-PERT vs. post-PERT. In-hospital mortality (8.5 % vs. 5.0 %, p = 0.29) and 30-day all-cause mortality (1.2 % vs. 0.5 %, p = 0.28) were not different between the two groups as well.Conclusion: At our institution, PERT was associated with a decrease in advanced therapies administered to acute PE patients without affecting mortality or LOS. Additional studies to assess impact of this multi-disciplinary care team model on interventional therapies and clinical outcomes for PE at a broader level are necessary.

Purpose:The aim of this study is to identify highly cited articles and examine trends and characteristics in research on periacetabular osteotomy.Materials and Methods:The 50 most highly cited articles on periacetabular osteotomy research were identified using Scopus. Data regarding article demographics and publication were collected from each article and an analysis was performed.Results:The mean citation count was 125±37. The article with the highest total citation count (796), five-year citation count (327), and five-year citation density (65/year) was reported by Reinhold Ganz. The five-year citation density showed strong correlation with total citation density (r=0.930, P<0.001). Reinhold Ganz, the most productive author, was listed on 13 articles in the cohort with 455 weighted citation points.Conclusion:This study provides a collection of articles examining periacetabular osteotomies and demonstrates that citation count can be regarded as an acceptable measure of the contemporary academic influence of an article.

Background With rising healthcare costs and campaigns aimed at avoiding low-value care, reducing cancer overtreatment has emerged as an important measure of cancer care quality. The extent to which avoidance of low-value care has been incorporated in cancer-specific quality measures is unknown. We aimed to identify and characterize cancer quality measures that promote the avoidance of low-value care, and identify gaps that may guide future measure development. Methods We systematically identified cancer-specific quality measures from leading quality measure organizations [e.g., National Quality Forum (NQF), National Quality Measures Clearinghouse (NQMC)]. We reviewed measures promoting the avoidance of low-value cancer care and subclassified them into disease site- or non-disease site-specific categories and the phase of care they targeted. Results We reviewed 313 quality measures from six organizations. Of these, 18% (n = 55) focused on avoidance of low-value care. Quality measures focused on end-of-life care were most likely to focus on low-value care [n = 13 (50%)], followed by breast [n = 12 (18%)], lung [n = 9 (31%)], colon [n = 8 (20%)], prostate [n = 5 (38%)], general cancer care [n = 4 (3%)], symptoms and toxicities [n = 2 (40%)], and palliative cancer care [n = 2 (11%)] measures. The phases of care quality measures targeted included low-value screening [n = 5 (9%)], diagnostic testing and staging [n = 7 (13%)], treatment [n = 19 (34%)], surveillance [n = 6 (11%)], and clinical outcomes [n = 18 (33%)]. All categories had a treatment-specific quality measure, but no category had a representative measure for every phase of care. Discussion A minority of cancer quality measures are aimed at avoiding low-value care, and multiple evidence-based recommendations targeting low-value care have not been incorporated.

Acetabular fractures are often first evaluated in the emergency department, where physicians with little experience reading pelvic radiographs may be required to make an accurate diagnosis and early management decisions. In this study, medical students classified radiographs of 20 acetabular fractures and repeated the exercise three weeks later with the aid of a previously described algorithm; half the students were given a lesson prior to using the algorithm. The pre-algorithm accuracy was 4/20 and the post-algorithm accuracy was 8.3/20 (p<0.01). The lesson provided no difference (p=0.5). This algorithm is therefore a useful reference to help classify and triage acetabular fractures.

INTRODUCTION:Pelvic and acetabular fracture incidence is increasing worldwide for more than four decades. There is currently no evidence examining risk factors for loss to follow up in patients with these injuries.METHODS:Patients presenting with pelvic and/or acetabular fractures at our institution between 2015 and 2020 were included. Demographic, injury, treatment, and follow up information was included. Excluded patients were those who sustained a pathologic fracture, has a course of treatment prior to transfer to our centre, or expired prior to discharge.RESULTS:446 patients, 263 with a pelvic ring injury, 172 with an acetabular fracture, and 11 with combined injuries were identified. 271 (61%) of patients in our cohort followed up in Orthopaedic clinic (p = 0.016). With an odds ratio of 2.134, gunshot wound mechanism of injury was the largest risk factor for loss to follow up (p = 0.031) followed by male sex (OR= 1.859) and surgery with general trauma surgery (OR=1.841). The most protective risk factors for follow up with Orthopaedic surgery were operatively treated pelvic and acetabular fractures (OR=0.239) and Orthopaedic Surgery as the discharging service (OR=0.372).DISCUSSION:Numerous risk factors exist for loss to follow up including male sex, ballistic mechanism, and discharging service. Investigation into interventions to improve follow up in these patients are warranted.

Importance:Surveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC.Objective:To characterize current surveillance practices and explore clinician attitudes and beliefs on deintensifying surveillance for patients with HNC.Design, Setting, and Participants:This qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies.Main Outcomes and Measures:The main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients' values and perspectives collected from interviews of participating physicians.Results:Twenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance.Conclusions and Relevance:In this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.