ROUTINE FOLLOW-UP OF BREAST-CANCER IN PRIMARY-CARE - RANDOMIZED TRIAL

Objective-To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow u p of women with breast cancer in remission from hospital to general pr actice. Design-Randomised controlled trial with 18 month follow up in which women received routine follow up either in hospital or in genera l practice. Subjects and setting-296 women with breast cancer in remis sion receiving regular follow up care at district general hospitals in England. Main outcome measures-Time between first presentation of sym ptoms to confirmation of recurrence; quality of life measured by speci fic dimensions of the SF-36 schedule, the EORTC symptom scale, and hos pital anxiety and depression scale. Results-Most recurrences (18/26, 6 9%) presented as interval events, and almost half (7/16, 44%) of the r ecurrences in the hospital group presented first to general practice. The median time to hospital confirmation of recurrence was 21 days in the hospital group (range 1-376 days) and 22 days in the general pract ice group (range 4-64). The differences between groups in the change i n SF-36 mean scores from baseline were small: -1.8 (95% confidence int erval -7.2 to 3.5) for social functioning, 0.5 (-4.1 to 5.1) for menta l health, and 0.6 (-3.6 to 4.8) for general health perception. The cha nge from baseline in the mean depression score was higher in the gener al practice group at the mid-trial assessment (difference 0.6, 0.1 to 1.2) but there was no significant difference between groups in the anx iety score or the EORTC scales. Conclusion-General practice follow up of women with breast cancer in remission is not associated with increa se in time to diagnosis, increase in anxiety, or deterioration in heal th related quality of life. Most recurrences are detected by women as interval events and present to the general practitioner, irrespective of continuing hospital follow up.