Article type
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Abstract
Background: Despite the limited scientific evidence that they can really make a difference for patients quantity and quality of life, follow-up programs after primary treatment are commonplace in the care of breast cancer patients. Objective: To assess the effectiveness of different policies of follow-up on mortality, morbidity and quality of life in breast cancer patients. Primary studies were searched through a thorough and systematic search of Medline, Embase as well as the Cochrane Breast Cancer Review Group specialised registry.
Results: Four randomised control trials (RCTs) involving 3204 women with breast cancer (clinical stage I, II or III) were eventually included in this review. Two reviewers independently assessed trials quality and criteria for inclusion. Two RCTs, involving 2563 patients, compared follow-up based on clinical visits and mammography only with a more intensive surveillance including radiological and laboratory tests. Metanalysis on Individual Patient Data showed no differences in overall survival (hazard ratio 0,96, 95% confidence interval 0,80-1,15), disease-free survival (hazard ratio 0,84, 95% confidence interval 0,71-1,00). No differences also emerged in overall survival and disease-free survival within subgroups according to age, tumour size and nodal status. One trial involving 296 patients compared follow-up offered by a specialist at the hospital with follow-up offered by a general practitioner. No differences in time to detection of recurrence and health related quality of life emerged. One trial, involving 196 patients, compared conventionally scheduled follow-up and follow-up restricted to the time of mammography: no differences in use of telephone and GP consultations between groups.
Conclusions: Follow-up based on clinical visits and mammography appear to be equally effective than a more intensive surveillance policy in terms of survival and quality of life. Giving primary responsibility for follow-up to general practitioners (as opposed to specialised centres) is well accepted by patients, does not negatively affect their quality of life not timing of detection of disease recurrence.
Results: Four randomised control trials (RCTs) involving 3204 women with breast cancer (clinical stage I, II or III) were eventually included in this review. Two reviewers independently assessed trials quality and criteria for inclusion. Two RCTs, involving 2563 patients, compared follow-up based on clinical visits and mammography only with a more intensive surveillance including radiological and laboratory tests. Metanalysis on Individual Patient Data showed no differences in overall survival (hazard ratio 0,96, 95% confidence interval 0,80-1,15), disease-free survival (hazard ratio 0,84, 95% confidence interval 0,71-1,00). No differences also emerged in overall survival and disease-free survival within subgroups according to age, tumour size and nodal status. One trial involving 296 patients compared follow-up offered by a specialist at the hospital with follow-up offered by a general practitioner. No differences in time to detection of recurrence and health related quality of life emerged. One trial, involving 196 patients, compared conventionally scheduled follow-up and follow-up restricted to the time of mammography: no differences in use of telephone and GP consultations between groups.
Conclusions: Follow-up based on clinical visits and mammography appear to be equally effective than a more intensive surveillance policy in terms of survival and quality of life. Giving primary responsibility for follow-up to general practitioners (as opposed to specialised centres) is well accepted by patients, does not negatively affect their quality of life not timing of detection of disease recurrence.