Follow-up of cancer in primary care versus secondary care: systematic review.
BACKGROUND
Cancer follow-up has traditionally been undertaken in secondary care, but there are increasing calls to deliver it in primary care.


OBJECTIVE
To compare the effectiveness and cost-effectiveness of primary versus secondary care follow-up of cancer patients, determine the effectiveness of the integration of primary care in routine hospital follow-up, and evaluate the impact of patient-initiated follow-up on primary care.


METHODS
Systematic review.


METHODS
Primary and secondary care settings.


METHODS
A search was carried out of 19 electronic databases, online trial registries, conference proceedings, and bibliographies of included studies. The review included comparative studies or economic evaluations of primary versus secondary care follow-up, hospital follow-up with formal primary care involvement versus conventional hospital follow-up, and hospital follow-up versus patient-initiated or minimal follow-up if the study reported the impact on primary care.


RESULTS
There was no statistically significant difference for patient wellbeing, recurrence rate, survival, recurrence-related serious clinical events, diagnostic delay, or patient satisfaction. GP-led breast cancer follow-up was cheaper than hospital follow-up. Intensified primary health care resulted in increased home-care nurse contact, and improved discharge summary led to increased GP contact. Evaluation of patient-initiated or minimal follow-up found no statistically significant impact on the number of GP consultations or cancer-related referrals.


CONCLUSIONS
Weak evidence suggests that breast cancer follow-up in primary care is effective. Interventions improving communication between primary and secondary care could lead to greater GP involvement. Discontinuation of formal follow-up may not increase GP workload. However, the quality of the data in general was poor, and no firm conclusions can be reached.
Lewis
Ruth A
RA
Department of Primary Care and Public Health, North Wales Clinical School, School of Medicine, Cardiff University, Wrexham. lewisr17@cf.ac.uk
Neal
Richard D
RD
Williams
Nefyn H
NH
France
Barbara
B
Hendry
Maggie
M
Russell
Daphne
D
Hughes
Dyfrig A
DA
Russell
Ian
I
Stuart
Nicholas S A
NS
Weller
David
D
Wilkinson
Clare
C
D000553:Ambulatory Care / Q000191:economics / Q000592:standards; D003266:Continuity of Patient Care / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005194:Family Practice / Q000191:economics / Q000592:standards; D006801:Humans; D009369:Neoplasms / Q000191:economics / Q000628:therapy*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D016032:Randomized Controlled Trials as Topic