Follow‐up after breast cancer: Variations, best practices, and opportunities for improvement according to health care professionals

Abstract

Objective: Follow-up after breast cancer can be divided into surveillance and aftercare. It remains unclear how follow-up can ideally be organised from the perspective of health care professionals (HCPs). The aim of this study was to gain insight in the organisation of follow-up in seven Dutch teaching hospitals and to identify best practices and opportunities for improvement of breast cancer (all stages) follow-up as proposed by HCPs.Methods: Semi-structured in-depth group interviews were performed, one in each of the participating hospitals, with in total 16 HCPs and 2 patient advocates. To describe the organisation of follow-up, transcripts were analysed using a deductive approach. Best practices and opportunities were derived using an inductive approach.Results: Variation was found in the organisation of aftercare, especially in timing, frequency, and disciplines of involved HCPs. Less variation was observed for surveillance, which was guided by the national guideline. Best practices focused on case management and adequate collaboration between HCPs of different disciplines.Mentioned opportunities were improving the structured monitoring of patients' needs and a comprehensive guideline for organisation and content of aftercare.Conclusions: Variation in follow-up existed between hospitals. Shared decisionmaking (SDM) about surveillance is desirable to ensure that surveillance matches the patient needs, preferences, and personal risk for recurrences.

Needs and preferences of breast cancer survivors regarding outcome-based shared decision-making about personalised post-treatment surveillance

“…We planned to recruit at least 15 patients to achieve data saturation [13]. In the Netherlands, early stage breast cancer patients (M0) are mostly surgically treated and therefore followed by the surgery department (by a surgical oncologist or a nurse practitioner from the surgery department) for surveillance [14]. Therefore, we recruited patients by contacting the surgery departments of the participating hospitals.…”

Health care professionals overestimate the risk for locoregional recurrences after breast cancer treatment depending on their specialty

“…The large overestimation by GPs could be due to a knowledge-gap on the effects of different therapies, experience with estimating risks for LRR due to a small number of patients with breast cancer in their practice, and the use of prediction models. GPs are currently hardly actively involved in surveillance after breast cancer [ 10 ]. However, this may change as follow-up shifts more towards a patient-led flexible model.…”

“…Recent studies have shown that shared decision-making about personalised surveillance is desirable [ 10 , 12 ]. General overestimations of the risk for LRR might hinder objective patient information which is required for shared decision-making.…”

Health care professionals' perspectives on shared decision making supported by personalised‐risk‐for‐recurrences‐calculations regarding surveillance after breast cancer

“…HCPs were selected based on their role in the follow‐up care process. Through an earlier assessment in each of the Santeon hospitals (Ankersmid et al, 2021), the researchers had knowledge on which specialisms were specifically involved in surveillance for breast cancer patients. In each hospital, one or two HCPs of the involved specialisms were approached for an interview (in total 24 HCPs).…”

“…The INFLUENCE‐nomogram is a validated prognostic model to calculate the 5‐year risk for locoregional recurrences (LRRs) after breast cancer (Voelkel et al, 2019; Witteveen et al, 2015) and second primary breast tumours (Völkel et al, 2021), based upon characteristics such as TNM stage, receptor status and adjuvant treatment. Although the INFLUENCE‐nomogram has been available for some years now its uptake in clinical practice is limited (Ankersmid et al, 2021) and little is known about how this nomogram can best be used in clinical practice and on how HCPs feel about using patients' estimated personal risk for LRRs as part of the SDM process on surveillance.…”