Evaluating primary care follow-up of breast cancer: methods and preliminary results of three studies.
Grunfeld E., Mant D., Vessey MP., Yudkin P.
OBJECTIVE: To evaluate a primary care centred system of routine follow-up of women with breast cancer in remission. DESIGN, PATIENTS AND OUTCOME MEASURES: Three related studies are reported: 1) A randomized controlled trial (RCT) involving 296 women with breast cancer in remission (stage I, II, or III) all receiving routine follow-up at two district general hospitals in England. Women in the control group received follow-up in hospital clinics according to the usual practice. Women in the experimental group received follow-up from their own general practitioners (GP), and were referred back to hospital clinics if any breast cancer related problems developed. The main outcome of the trial was 'diagnostic delay': the time from the first presentation of signs or symptoms suggestive of recurrence to the time that recurrence was diagnosed. 2) A prospective descriptive study of a cohort of 141 women who were eligible for the trial, but who declined to participate. 3) A national survey of 376 specialists in breast cancer, and a survey of 226 general practitioners of the patients eligible for the RCT described above, to determine their views on follow-up of breast cancer in remission. RESULTS: 1) The randomized trial to evaluate primary care follow-up of breast cancer in remission has been successfully conducted and final results are pending. 2) Patients who were eligible but declined to participate in the trial were significantly older than participants (mean age 64.3 years compared with 60.7 years; difference 3.6 years; 95% confidence interval 0.53; 6.59). The two groups were similar in clinical characteristics and quality of life. 3) The majority of specialists and GPs preferred a system of routine follow-up which was primarily provided by their own professional group. CONCLUSIONS: A general practice centred system of routine follow-up of women with breast cancer in remission is acceptable to both patients and general practitioners. Final results of a randomized trial evaluating quality of care and quality of life outcome measures are pending.