Questioning specialists’ attitudes to breast cancer follow-up in primary care
Open Access
- 24 May 2007
- journal article
- research article
- Published by Elsevier BV in Annals of Oncology
- Vol. 18 (9), 1467-1476
- https://doi.org/10.1093/annonc/mdm193
Abstract
Background: National Institute for Clinical Excellence (NICE) guidelines recommend discharging asymptomatic breast care patients 3 years after diagnosis. A role for General Practitioners (GPs) and breast care nurses is proposed, together with skills training, but it remains unclear for how long breast cancer patients should be followed up, what tests should be done, and who should be conducting the follow-up. We therefore surveyed Breast Cancer Specialists. Design: A 20-point questionnaire was sent to 562 Specialists registered in the Cancer Research Clinical Trials Unit database, with questions on case-load, perceptions of follow-up, local policy and opinions on greater primary care involvement. Results: The most commonly acknowledged purpose of follow-up was detection of treatment-related morbidity. Eighty four percent of respondents adhered to a locally developed protocol with only 9% conforming to NICE guidelines. The median follow-up was 5 years. Significant factors predicting delayed discharge were younger age (P ≤ 0.0001); poorer Nottingham Prognostic Index (P = 0.003); treatment factors (P = 0.002); and patient risk factors (P = 0.003). Centres with higher case-loads (>200/year) were more likely to discharge earlier. Reduced workload was perceived as the main benefit of discharge, while lack of GP oncological experience and loss of outcome data were concerns. Conclusions: Specialists favour a risk adjusted discharge strategy and increased oncology infrastructure in primary care.Keywords
This publication has 21 references indexed in Scilit:
- General practitioners with special interests: evolution and evaluationJournal of Health Services Research & Policy, 2006
- Aromatase inhibitors for early breast cancer therapy: A choice of effective treatment strategiesEuropean Journal of Surgical Oncology, 2006
- Guidelines for the management of symptomatic breast diseaseEuropean Journal of Surgical Oncology, 2005
- Follow-up care of patients treated for breast cancer: a structured reviewCancer Treatment Reviews, 2004
- Routine follow up of breast cancer in primary care: randomised trialBMJ, 1996
- Potential for cost economies in guiding therapy in patients with metastatic breast cancerBritish Journal of Cancer, 1995
- A survey in Puglia: The attitudes and opinions of specialists, general physicians and patients on follow-up practiceAnnals of Oncology, 1995
- Evaluating primary care follow-up of breast cancer: Methods and preliminary results of three studiesAnnals of Oncology, 1995
- Heterogeneity of cancer surveillance practices among medical oncologists in Washington and OregonCancer, 1995
- Postoperative follow-up of patients with early breast cancer. Patterns of care among clinical oncologists and a review of the literatureCancer, 1991