title: Questioning specialists' attitudes to breast cancer follow-up in primary care.
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.
  
  
  METHODS
  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 < or = 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.
authors.affiliation: Breast Care Directorate, South Devon Healthcare NHS Foundation Trust, Torquay, UK. peter.donnelly@nhs.net
authors.forename: P
authors.initials: P
authors.lastname: Donnelly
authors.forename: L
authors.initials: L
authors.lastname: Hiller
authors.forename: S
authors.initials: S
authors.lastname: Bathers
authors.forename: S
authors.initials: S
authors.lastname: Bowden
authors.forename: R
authors.initials: R
authors.lastname: Coleman
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008495:Medical Oncology / Q000193:education; D009364:Neoplasm Recurrence, Local; D010351:Patient Discharge; D011320:Primary Health Care; D012306:Risk; D011795:Surveys and Questionnaires