Family Doctors Provide Appropriate Follow-Up Care for Early Breast CancerKey Words
Breast cancer, follow-up care, family doctors. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)
Summary
A large randomized trial of women who had completed treatment for early-stage breast cancer found that primary care physicians and cancer specialists provide follow-up care of equal quality. The findings suggest that, in general, women who prefer to see their family doctor for follow-up care do not have to worry about decreased quality of life or an increased risk of a serious clinical event due to an undetected recurrence.
Source
Journal of Clinical Oncology, published online Jan. 17, 2006; in print February 20, 2006 (see the journal abstract).
(J Clin Oncol. 2006 Jan 17; [Epub ahead of print])
Background
After treatment for early-stage breast cancer, women need regular follow-up visits to monitor their health and check for a recurrence. Follow-up care in most Western countries has traditionally been provided by cancer specialists (oncologists).
However, preliminary studies have suggested that patient satisfaction increases when follow-up care is handled by a primary care physician, with no reduction in quality of life or increase in time to diagnosis of recurrence. The authors designed the current study to address this question more definitively.
The Study
Nine hundred and sixty-eight women who had completed chemotherapy or radiation therapy after surgery for early-stage breast cancer participated in the study at six regional cancer centers in Ontario, Canada. The women were randomly assigned to receive follow-up care from either a cancer center doctor or from their own family doctor.
Participating family doctors received one-page guidelines that recommended the timing for follow-up visits and required tests. The investigators measured the incidence of recurrence-related serious clinical events in both groups and assessed health-related quality of life.
The study’s lead author is Eva Grunfeld, M.D., D. Phil., of the Dalhousie University Division of Medical Oncology in Halifax, Nova Scotia, Canada.
Results
Participating women were followed for a
median of 4.5 years after diagnosis, the period in which most relapses occur. No statistically significant differences were found between the two groups in either the quality of life issues or the number of serious clinical events (for example, uncontrolled local recurrence or spinal cord compression).
Comments
In an accompanying editorial, James Khatcheressian, M.D., and Thomas Smith, M.D., of the Massey Cancer Center of Virginia Commonwealth University in Richmond, Va., write that the study “shows conclusively that the health outcomes for women after primary treatment of breast cancer are the same if they are followed by their family physicians or cancer center specialists.”
The study’s authors note that reliance on family doctors for follow-up breast cancer care is “likely to be more convenient…and potentially less costly” to the patient. However, they emphasize that if family doctors do assume more responsibility for follow-up care, the oncology community must make an effort to keep them informed about the most up-to-date standards of treatment.
This sentiment is seconded by Jo Anne Zujewski, M.D., a medical oncologist and breast cancer specialist with the National Cancer Institute’s Cancer Therapy Evaluation Program: “If changes in practice do occur, the information needs to go out to primary physicians.”
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