FOLLOW-UP AFTER TREATMENT FOR BREAST-CANCER

Objective: To assist patients and their physicians in arriving at the most effective follow-up strategy after treatment for breast cancer. O utcomes: Survival, metastasis-free survival, local recurrence, quality of life. Evidence: Evidence was based on a literature review using ME DLINE for the years 1991 to 1996, references cited in reviews and cons ensus conference proceedings. Recommendations: All patients who have c ompleted their primary treatment for breast cancer should have regular follow-up surveillance. The frequency of follow-up visits should be a djusted according to individual patient's needs. The following issues and schedule should be considered: (a) The need to discuss and manage early side effects of therapy, plan a follow-up program and provide ge neral support. (This visit is usually scheduled 4 to 6 weeks after the rapy.) (b) The need to establish a post-treatment baseline, detect ear ly recurrences and teach breast self-examination. (This visit is usual ly 4 to 6 months after therapy.) (c) The need for regular physical and mammographic examination to detect potentially curable disease. (Thes e examinations should be at approximately 1-year intervals indefinitel y thereafter.) (d) The need to provide support and counselling may req uire additional visits for some women, particularly for the first few years. (e) If metastases develop, the frequency of visits must be dete rmined by the symptoms, course of disease and need for further treatme nt. All visits should include a medical history. For women who are tak ing tamoxifen, it is important to ask about vaginal bleeding. Physical examination should include both breasts, regional lymph nodes, chest wall and abdomen. The arms should be examined for lymphedema. Annual v isits should include mammographic examination. Routine laboratory and radiographic investigations should not be carried out for the purpose of detecting distant metastases. Patients should be encouraged to repo rt new, persistent symptoms promptly, without waiting for the next sch eduled appointment. Breast self-examination should be taught to those women who wish to carry it out. Psychosocial support should be encoura ged and facilitated. Participation in clinical trials should be facili tated and encouraged. The responsibility for follow-up care should be formally allocated to a single physician, with the patient participati ng as much as possible. The patients should always be fully informed o f these arrangements. Communication between all members of the therape utic team must be ensured to avoid duplication of visits and tests. Va lidation: Successive reviews and revisions of this document were carri ed out by a writing committee, expert primary reviewers, secondary rev iewers from across Canada, and by the Steering Committee. This final v ersion reflects a substantial consensus of all individuals involved. T his guideline has been reviewed and approved by the Canadian Associati on of Radiation Oncologists.