Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care.
OBJECTIVE
Most women with breast cancer are diagnosed at an early stage and more than 80% will be long-term survivors. Routine follow-up marks the transition from intensive treatment to survivorship. It is usual practice for routine follow-up to take place in specialist clinics. This study tested the hypothesis that follow-up by the patient's family physician is a safe and acceptable alternative to specialist follow-up.


METHODS
A multicenter, randomized, controlled trial was conducted involving 968 patients with early-stage breast cancer who had completed adjuvant treatment, were disease free, and were between 9 and 15 months after diagnosis. Patients may have continued receiving adjuvant hormonal therapy. Patients were randomly allocated to follow-up in the cancer center according to usual practice (CC group) or follow-up from their own family physician (FP group). The primary outcome was the rate of recurrence-related serious clinical events (SCEs). The secondary outcome was health-related quality of life (HRQL).


RESULTS
In the FP group, there were 54 recurrences (11.2%) and 29 deaths (6.0%). In the CC group, there were 64 recurrences (13.2%) and 30 deaths (6.2%). In the FP group, 17 patients (3.5%) compared with 18 patients (3.7%) in the CC group experienced an SCE (0.19% difference; 95% CI, -2.26% to 2.65%). No statistically significant differences (P < .05) were detected between groups on any of the HRQL questionnaires.


CONCLUSIONS
Breast cancer patients can be offered follow-up by their family physician without concern that important recurrence-related SCEs will occur more frequently or that HRQL will be negatively affected.
Grunfeld
Eva
E
Cancer Outcomes Research Program, Cancer Care Nova Scotia and Dalhousie University, Halifax, Nova Scotia. Eva.Grunfeld@ccns.nshealth.ca
Levine
Mark N
MN
Julian
Jim A
JA
Coyle
Doug
D
Szechtman
Barbara
B
Mirsky
Doug
D
Verma
Shailendara
S
Dent
Susan
S
Sawka
Carol
C
Pritchard
Kathleen I
KI
Ginsburg
David
D
Wood
Marjorie
M
Whelan
Tim
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001943:Breast Neoplasms / Q000473:pathology* / Q000517:prevention & control*; D002173:Cancer Care Facilities / Q000592:standards; D003266:Continuity of Patient Care; D005194:Family Practice / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011159:Population Surveillance / Q000379:methods*; D011788:Quality of Life