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24 May 2007
Study Slams Breast Cancer Follow-Up Care 
A new study from the UK, appearing in the Annals of Oncology, says that follow-up of breast cancer patients after their initial treatment is becoming "devalued and deregulated". The authors say that if follow-up was well co-ordinated and made better use of community-based teams of doctors and nurses, then health authorities could make large financial savings that could be put towards giving patients better access to new and expensive adjuvant drugs (such as aromatase inhibitors), as well as enabling them to see relevant hospital specialists more quickly. Cancer specialists would gain more time to concentrate on patients with more complex needs, while patients would gain better care and psychological support in their local communities. Peter Donnelly, the lead author of the study, found that only nine percent of cancer specialists discharged patients according to protocols that conformed with guidelines from NICE (the UK's National Institute for Health and Clinical Excellence), the duration of follow-up by the specialists ranged between a year to more than ten years in some cases, and the frequency of mammographies for invasive and non-invasive disease varied between one and three years. Specialists cited lack of confidence in general practitioners' experience and training in oncology and loss of data on patient outcome as their main concerns about discharging patients into the care of the local doctors and nurses. The research by Donnelly and his colleagues revealed that: - Although 84% of specialists had a protocol for managing follow-up, only 9% conformed to NICE guidelines;
- Only 18% of specialists offered patients a choice of follow-up protocol, of whom only 9% routinely gave patients a written plan;
- For invasive disease, 67% arranged annual mammograms, 9% every 18 months, 18% two-yearly, and 3% three-yearly. For non-invasive disease, the figures were similar (62%, 10%, 19% and 2% respectively);
- Average follow-up time was five years, with variations from one year to over ten years. Discharge at three years was arranged most frequently for patients considered to be at low risk;
- Metropolitan hospitals tended to provide longer follow-up than district hospitals for patients at high risk from either recurrence or treatment-related problems.
"This study shows that the NICE recommendations that follow-up should be no longer than three years are not considered safe or acceptable by specialists, and that the majority of clinics are in breach of these guidelines by choosing to discharge at five or more years after treatment," said Donnelly. "It might be better if the guidelines reflected current practice and concerns, particularly the lack of confidence in the community support for breast cancer. There appears to be widespread concern regarding the level of oncology knowledge among GPs, and their ability to develop and use follow-up protocols for high-risk patients." Source: European Society for Medical Oncology
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