A large randomized trial of women who had completed treatment for early-stage breast cancer found that primary care physicians and cancer specialists provide follow-up care of equal quality, according to a study in an early online edition of the Journal of Clinical Oncology. The findings suggest that, in general, women who prefer to see their family physicians for follow-up care do not have to worry about decreased quality of life or an increased risk of a serious clinical event due to an undetected recurrence.
After treatment for early-stage breast cancer, women need regular follow-up visits to monitor their health and check for a recurrence. Follow-up care in most Western countries has traditionally been provided by cancer specialists (oncologists).
However, preliminary studies have suggested that patient satisfaction increases when follow-up care is handled by a primary care physician, with no reduction in quality of life or increase in time to diagnosis of recurrence. The authors designed the current study to address this question more definitively.
Nine hundred sixty-eight women who had completed chemotherapy or radiation therapy after surgery for early-stage breast cancer participated in the study at six regional cancer centers in Ontario, Canada. The women were randomly assigned to receive follow-up care from either a cancer center doctor or from their own family physician.
Participating family physicians received one-page guidelines that recommended the timing for follow-up visits and required tests. The investigators measured the incidence of recurrence-related serious clinical events in both groups and assessed health-related quality of life.
The study's lead author is Dr. Eva Grunfeld of the Dalhousie University Division of Medical Oncology in Halifax, Nova Scotia, Canada.
Participating women were followed for a median of 4.5 years after diagnosis, the period in which most relapses occur. No statistically significant differences were found between the two groups in either quality of life issues or the number of serious clinical events (for example, uncontrolled local recurrence or spinal cord compression).
In an accompanying editorial, Drs. James Khatcheressian and Thomas Smith, of the Massey Cancer Center of Virginia Commonwealth University in Richmond, write that the study "shows conclusively that the health outcomes for women after primary treatment of breast cancer are the same if they are followed by their family physicians or cancer center specialists."
The study's authors note that reliance on family physicians for follow-up breast cancer care is "likely to be more convenient…and potentially less costly" to the patient. However, they emphasize that if family physicians do assume more responsibility for follow-up care, the oncology community must make an effort to keep them informed about the most up-to-date standards of treatment.
Dr. Jo Anne Zujewski, a medical oncologist and breast cancer specialist with NCI's Cancer Therapy Evaluation Program, agrees with this sentiment: "If changes in practice do occur, the information needs to go out to primary physicians."
By Sharon Reynolds