Optimizing follow-up after breast cancer treatment.
OBJECTIVE
This review focuses on studies that help elucidate the optimum approach to posttreatment follow-up of breast cancer patients.


RESULTS
The re-conceptualization of follow-up under the rubric of survivorship care and the benefit of survivorship care plans, studies on the elements of follow-up care including surveillance mammograms, alternative models of follow-up care including primary care based follow-up, and patterns of care studies that involve population-based samples are discussed. Posttreatment follow-up of breast cancer patients continues to be controversial despite almost two decades of research. The research does show that surveillance mammograms are beneficial and guidelines recommend routine surveillance mammograms annually. Other routine surveillance tests are not beneficial and are not recommended. The precise frequency and duration of clinical visits is not known and recommendations vary; but most do support continued clinical assessment. Alternative models, such as nurse-led follow-up or less frequent follow-up, show good patient satisfaction and quality-of-life outcomes. Primary care based followup results in similar clinical and quality-of-life outcomes as specialist-based follow-up.


CONCLUSIONS
Instead of trying to find a one-size-fits-all approach, the focus should be on an individualized tailored approach in which the patient makes an informed decision on the basis of evidence of actual benefits and risks.
Grunfeld
Eva
E
Ontario Institute of Cancer Research and University ofToronto, Toronto, Ontario, Canada. eva.grunfeld@utoronto.ca
D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D010347:Patient Care Planning / Q000458:organization & administration*; D015996:Survival Rate