title: Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care.
abstract: 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.
authors.affiliation: Cancer Outcomes Research Program, Cancer Care Nova Scotia and Dalhousie University, Halifax, Nova Scotia. Eva.Grunfeld@ccns.nshealth.ca
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
authors.forename: Jim A
authors.initials: JA
authors.lastname: Julian
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.forename: Barbara
authors.initials: B
authors.lastname: Szechtman
authors.forename: Doug
authors.initials: D
authors.lastname: Mirsky
authors.forename: Shailendara
authors.initials: S
authors.lastname: Verma
authors.forename: Susan
authors.initials: S
authors.lastname: Dent
authors.forename: Carol
authors.initials: C
authors.lastname: Sawka
authors.forename: Kathleen I
authors.initials: KI
authors.lastname: Pritchard
authors.forename: David
authors.initials: D
authors.lastname: Ginsburg
authors.forename: Marjorie
authors.initials: M
authors.lastname: Wood
authors.forename: Tim
authors.initials: T
authors.lastname: Whelan
mesh_terms: 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