Follow-up strategies for women treated for early breast cancer

Abstract

Cochrane Database of Systematic Reviews analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for one trial of these trials, and no significant di erences in overall survival were found. No di erence was noted in quality of life measures (one study, 639 participants, high-quality evidence). The new included trial, together with a previously included trial involving 1264 women compared follow-up performed by a hospitalbased specialist versus follow-up performed by general practitioners. No significant di erences were noted in overall survival (HR 1.07, 95% CI 0.64 to 1.78, one study, 968 participants, moderate-quality evidence), time to detection of recurrence (HR 1.06, 95% CI 0.76 to 1.47, two studies, 1264 participants, moderate-quality evidence), and quality of life (one study, 356 participants, high-quality evidence). Patient satisfaction was greater among patients treated by general practitioners. One RCT involving 196 women compared regularly scheduled follow-up visits versus less frequent visits restricted to the time of mammography. No significant di erences emerged in interim use of telephone and frequency of general practitioners's consultations. Authors' conclusions This updated review of RCTs conducted almost 20 years ago suggests that follow-up programs based on regular physical examinations and yearly mammography alone are as e ective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life. In two RCTs, follow-up care performed by trained and not trained general practitioners working in an organised practice setting had comparable e ectiveness to that delivered by hospital-based specialists in terms of overall survival, recurrence detection, and quality of life.

Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis

“…At the time of the study current practice across the Yorkshire Cancer Network, UK was to provide follow‐up for 5 years after completion of primary therapy; women may attend from 7 to 17 appointments over this period. The value of this resource intensive practice has been questioned for many years (Beaver & Luker, ; Gulliford, Opomu, Wilson, Hanham, & Epstein, ; Moschetti, Cinuini, Lambertini, Levaggi, & Liberati, ; Taggart, Donnelly, & Dunn, ). It had been acknowledged that routine hospital visits of asymptomatic breast cancer patients can be stressful to patients and serve no clinical benefit, apart from providing a platform for annual mammography (Puglisi et al., ).…”

“…It had been acknowledged that routine hospital visits of asymptomatic breast cancer patients can be stressful to patients and serve no clinical benefit, apart from providing a platform for annual mammography (Puglisi et al., ). Symptoms attributable to local recurrence are more commonly identified by the patient in the interval between clinic visits (Montgomery, ), or in general practice (Moschetti et al., ). Yet, the practice of regular follow‐up in breast clinics of essentially well women had become an entrenched practice in the UK contributing to health service burden and potentially lengthening waiting times for new referrals.…”

What do Cochrane systematic reviews say about the clinical effectiveness of screening and diagnostic tests for cancer?

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Among these, 7 reviews assessed a screening method only for the general population, 7 only for a specific subpopulation and 3 for both. The reviews assessed screening approaches for the following types of cancer: cancer in general (n = 2), bladder (n = 1), breast (n = 4), colorectal (n = 2), hepatic (n = 1), lung (n = 1), nasopharyngeal (n = 1), esophageal (n = 1), oral (n = 1), prostate (n = 1), testicular (n = 1) and uterine (n = 1).…”

Cancer Survivorship Care: A perspective from an Occupational- Participation Approach

“…Timely efforts are needed to identify and implement interventions that are aim at enabling health of cancer survivors. At present, research evidence is highlighting that chronic diseases may best be managed by a balance of traditional medical care and the day-to-day practice of self-management skills [31][32][33][34]. Therefore, it is timely to understand cancer survivorship from the perspective of 'occupational-participation', as factors acting as barrier or facilitator to execute the performance can be delineated and studied.…”