Patient initiated follow up of breast cancer

Abstract

This paper reports on a randomised controlled trial assessing two types of outpatient follow up for women previously treated for stage 1 breast cancer now in remission. These were standard clinic follow up (n = 31, age range: 48-83 years) and patient initiated follow up (n = 30, age range 53-87 years). The latter method involved giving the women written information on the signs and symptoms of recurrence and instructing them to telephone the Breast Care Nurse if they encountered any problems. The groups were compared in terms of cancer and breast cancer-specific quality of life, and psychological morbidity at recruitment, 6 months and 1 year. Satisfaction with follow up was assessed at 6 months and 1 year. Details regarding contact with healthcare professionals were collected at 1 year. There were no major differences in quality of life and psychological morbidity between the groups although more women in the standard clinic group reported reassurance and being checked as advantages whereas more women in the patient initiated follow up group reported convenience as an advantage. Patient initiated follow up is a potential alternative to standard clinic follow up for this group of women and appears to have no adverse effects. This could enable a cost saving to be made.

Alternative methods of follow up in breast cancer: a systematic review of the literature

“…From these abstracts, six full-length articles were obtained, all of which were eligible for inclusion in the analysis (Grunfeld et al, 1996Gulliford et al, 1997;Brown et al, 2002; Koinberg et al, 2004; Kokko et al, 2005). One abstract had been published as part of the proceedings of a scientific meeting and the data had not yet been published in full (Baildam et al, 2004).…”

“…Two trials compared follow up in hospital clinics with that provided by a general practitioner (Grunfeld et al, 1996, two compared traditional follow up with follow up merely on demand by contacting a breast care nurse (Brown et al, 2002;Koinberg et al, 2004) and one compared routine follow up by doctors with routine follow up by breast care nurses (Baildam et al, 2004). Two trials compared different frequencies of follow up within a traditional framework (Gulliford et al, 1997;Kokko et al, 2005).…”

“…One used a structured interview technique (Brown et al, 2002), whereas the other employed a questionnaire previously validated by the authors (Koinberg et al, 2004). Both reported high levels of satisfaction with follow up in both study and control groups, with no difference in satisfaction between the study and control groups in either trial.…”

“…Both reported high levels of satisfaction with follow up in both study and control groups, with no difference in satisfaction between the study and control groups in either trial. In the patient-initiated follow-up trial by Brown et al, there were differences in what patients perceived as advantages of different methods of follow up, with more women describing routine clinic visits as reassuring (w 2 :27.63, Po0.000, 1 df), whereas more men described ondemand follow up as convenient (w 2 :17.354, Po0.000, 1 df) (Brown et al, 2002).…”

“…Several trials looked at the issue of quality of life measured by validated tools such as the hospital anxiety and depression scale (HADS) (Grunfeld et al, 1996Brown et al, 2002;Baildam et al, 2004;Koinberg et al, 2004), European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BR23 (Grunfeld et al, 1996;Brown et al, 2002) and the Medical Outcomes Study Short Form 36-item General Health Survey (SF-36) (Grunfeld et al, 1996. None of these trials reported any differences in any of the scales between control and study groups at any stage in the respective trials.…”