Originally published as JCO Early Release 10.1200/JCO.2005.03.2235 on January 17 2006

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Randomized Trial of Long-Term Follow-Up for Early-Stage Breast Cancer: A Comparison of Family Physician Versus Specialist Care

From the Cancer Outcomes Research Program, Cancer Care Nova Scotia and Dalhousie University, Halifax, Nova Scotia; Ottawa Regional Cancer Centre and University of Ottawa; Ottawa Hospital and University of Ottawa, Ottawa; Ontario Clinical Oncology Group; Juravinski Regional Cancer Centre and McMaster University; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; Toronto-Sunnybrook Regional Cancer Centre and University of Toronto, Toronto; Northwestern Ontario Regional Cancer Centre, Thunder Bay; Kingston Regional Cancer Centre, Kingston, Ontario; and University of British Columbia, Vancouver, British Columbia, Canada

Address reprint requests to E. Grunfeld, MD, DPhil, Cancer Care Nova Scotia and Division of Medical Oncology, Dalhousie University, 1278 Tower Route, 5th Floor Bethune Building, Halifax, Nova Scotia, Canada B3H 2Y9; e-mail: Eva.Grunfeld{at}ccns.nshealth.ca

PURPOSE: Most women with breast cancer are diagnosed at an early stage and more than 80% will be long-term survivors. Routine follow-up marks the transition from intensive treatment to survivorship. It is usual practice for routine follow-up to take place in specialist clinics. This study tested the hypothesis that follow-up by the patient's family physician is a safe and acceptable alternative to specialist follow-up.

PATIENTS AND METHODS: A multicenter, randomized, controlled trial was conducted involving 968 patients with early-stage breast cancer who had completed adjuvant treatment, were disease free, and were between 9 and 15 months after diagnosis. Patients may have continued receiving adjuvant hormonal therapy. Patients were randomly allocated to follow-up in the cancer center according to usual practice (CC group) or follow-up from their own family physician (FP group). The primary outcome was the rate of recurrence-related serious clinical events (SCEs). The secondary outcome was health-related quality of life (HRQL).

RESULTS: In the FP group, there were 54 recurrences (11.2%) and 29 deaths (6.0%). In the CC group, there were 64 recurrences (13.2%) and 30 deaths (6.2%). In the FP group, 17 patients (3.5%) compared with 18 patients (3.7%) in the CC group experienced an SCE (0.19% difference; 95% CI, –2.26% to 2.65%). No statistically significant differences (P < .05) were detected between groups on any of the HRQL questionnaires.

CONCLUSION: Breast cancer patients can be offered follow-up by their family physician without concern that important recurrence-related SCEs will occur more frequently or that HRQL will be negatively affected.

Supported by Grant No. 010413 from the Canadian Breast Cancer Research Alliance. While conducting this study, Dr Grunfeld was a Career Scientist with the Ontario Ministry of Health and Long-term Care. The conclusions are those of the authors and no endorsement by the Ministry is intended or should be inferred.

Presented as a poster at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Randomized Trial of Long-Term Follow-Up for Early-Stage Breast Cancer: A Comparison of Family Physician Versus Specialist Care
  James L. Khatcheressian and Thomas J. Smith
  JCO 2006 24: 835-837 [Full Text]

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