EVALUATING PRIMARY-CARE FOLLOW-UP OF BREAST-CANCER - METHODS AND PRELIMINARY-RESULTS OF 3 STUDIES

Objective: To evaluate a primary care centred system of routine follow -up of women with breast cancer in remission. Design, patients and out come measures: Three related studies are reported: 1) A randomized con trolled trial (RCT) involving 296 women with breast cancer in remissio n (stage I, II, or III) all receiving routine follow-up at two distric t general hospitals in England. Women in the control group received fo llow-up in hospital clinics according to the usual practice. Women in the experimental group received follow-up from their own general pract itioners (GP), and were referred back to hospital clinics if any breas t 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 diag nosed. 2) A prospective descriptive study of a cohort of 141 women who were eligible for the trial, but who declined to participate. 3) A na tional 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 remis sion. Results: 1) The randomized trial to evaluate primary care follow up of breast cancer in remission has been successfully conducted and f inal results are pending. 2) Patients who were eligible but declined t o participate in the trial were significantly older than participants (mean age 64.3 years compared with 60.7 years; difference 3.6 years; 9 5% confidence interval 0.53; 6.59). The two groups were similar in cli nical characteristics and quality of life. 3) The majority of speciali sts and GPs preferred a system of routine follow-up which was primaril y provided by their own professional group. Conclusions: A general pra ctice 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 qu ality of life outcome measures are pending.