Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study

Abstract

Objective: To compare the experiences of patients with breast cancer who were conventionally monitored with those in whom routine follow up was restricted to the time of mammography. Design: Randomisation to conventional schedule of clinic visits or to visits only after mammography. Both cohorts received identical mammography and were invited to telephone for immediate appointments if they detected symptoms. Setting: Combined breast clinic, Chelsea and Westminster Hospital. Subjects: 211 eligible outpatients with a history of breast cancer. Main outcome measures: Acceptability of randomisation, interim use of telephone and general practitioner, satisfaction with allocation to follow up. Results: Of 211 eligible patients, 196 (93%) opted for randomisation in the study. Of these, 55 were under 50 years, 78 were diagnosed fewer than five years before, 90 had stage T2-4 tumours, and 71 had involved axillary nodes. Patients who did not participate were more likely to be under 50 years, to be two to five years after diagnosis, and to have had aggressive primary disease. Twice as many patients in both groups expressed a preference for reducing rather than increasing follow up. No increased use of local practitioner services or telephone triage was apparent in the cohort randomised to less frequent follow up by specialists. Conclusions: Reducing the frequency of routine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort. A multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes. Although it is standard practice to advocate routine long term follow up of patients with breast cancer, the effectiveness of non-mammographic follow up has not been assessed in randomised trials A key concern that has delayed the implementation of such trials is whether patients would find symptom driven follow up psychologically acceptable In this study most patients agreed to undergo randomisation to less frequent follow up, though all continued with routine mammographic review After randomisation more patients expressed a desire to reduce further, rather than increase, the frequency of follow up Patients undergoing less frequent review did not increase their use of general practitioner or telephone (hotline) services