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

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grunfeld, E. Articles by Whelan, T. Search for Related Content PubMed PubMed Citation Articles by Grunfeld, E. Articles by Whelan, T. Related Articles Related Editorial Social Bookmarking                            What's this?

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

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]

This article has been cited by other articles:

				L. A. Jacobs, S. C. Palmer, L. A. Schwartz, A. DeMichele, J. J. Mao, J. Carver, C. Gracia, C. E. Hill-Kayser, J. M. Metz, M. K. Hampshire, et al. Adult Cancer Survivorship: Evolution, Research, and Planning Care CA Cancer J Clin, November 1, 2009; 59(6): 391 - 410. [Abstract] [Full Text] [PDF]

				C. Earle Cancer Quality Alliance Proceedings: Caring Beyond Cancer J. Oncol. Pract, September 1, 2009; 5(5): 265 - 266. [Full Text] [PDF]

				P. Murchie, E. K Delaney, N. C Campbell, and P. C Hannaford GP-led melanoma follow-up: the practical experience of GPs Fam. Pract., August 1, 2009; 26(4): 317 - 324. [Abstract] [Full Text] [PDF]

				M. E. Del Giudice, E. Grunfeld, B. J. Harvey, E. Piliotis, and S. Verma Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors J. Clin. Oncol., July 10, 2009; 27(20): 3338 - 3345. [Abstract] [Full Text] [PDF]

				L. Nekhlyudov "Doc, Should I See You or My Oncologist?" A Primary Care Perspective on Opportunities and Challenges in Providing Comprehensive Care for Cancer Survivors J. Clin. Oncol., May 20, 2009; 27(15): 2424 - 2426. [Full Text] [PDF]

				H. L. McArthur, K. A. Gelmon, I. A. Olivotto, C. H. Speers, S. L. Ellard, S. E. O'Reilly, and H. F. Kennecke Effectiveness of a Letter Notification Program for Women With Early-Stage Breast Cancer Eligible for Extended Adjuvant Letrozole J. Clin. Oncol., March 20, 2009; 27(9): 1388 - 1393. [Abstract] [Full Text] [PDF]

				J. Sisler and P. McCormack-Speak Bridging the gap between primary care and the cancer system: The UPCON Network of CancerCare Manitoba Can Fam Physician, March 1, 2009; 55(3): 273 - 278. [Abstract] [Full Text] [PDF]

				C. F. Snyder, K. D. Frick, M. E. Kantsiper, K. S. Peairs, R. J. Herbert, A. L. Blackford, A. C. Wolff, and C. C. Earle Prevention, Screening, and Surveillance Care for Breast Cancer Survivors Compared With Controls: Changes from 1998 to 2002 J. Clin. Oncol., March 1, 2009; 27(7): 1054 - 1061. [Abstract] [Full Text] [PDF]

				J. J. Mao, M. A. Bowman, C. T. Stricker, A. DeMichele, L. Jacobs, D. Chan, and K. Armstrong Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients J. Clin. Oncol., February 20, 2009; 27(6): 933 - 938. [Abstract] [Full Text] [PDF]

				H. J. Smedira, R. J. Patrick, L. A. Rybicki, and J. P. Crowe Integrating Medical Breast Specialists Into the Traditional Breast Center Practice Model: A Review of 11 Years of Experience Arch Intern Med, October 13, 2008; 168(18): 2042 - 2045. [Full Text] [PDF]

				E. Grunfeld Primary Care Physicians and Oncologists Are Players on the Same Team J. Clin. Oncol., May 10, 2008; 26(14): 2246 - 2247. [Full Text] [PDF]

				C. F. Snyder, C. C. Earle, R. J. Herbert, B. A. Neville, A. L. Blackford, and K. D. Frick Preventive Care for Colorectal Cancer Survivors: A 5-Year Longitudinal Study J. Clin. Oncol., March 1, 2008; 26(7): 1073 - 1079. [Abstract] [Full Text] [PDF]

				P. A. Ganz and E. E. Hahn Implementing a Survivorship Care Plan for Patients With Breast Cancer J. Clin. Oncol., February 10, 2008; 26(5): 759 - 767. [Abstract] [Full Text] [PDF]

				P Donnelly, L Hiller, S Bathers, S Bowden, and R Coleman Questioning specialists' attitudes to breast cancer follow-up in primary care Ann. Onc., September 1, 2007; 18(9): 1467 - 1476. [Abstract] [Full Text] [PDF]

				N. L. Keating, M. B. Landrum, E. Guadagnoli, E. P. Winer, and J. Z. Ayanian Surveillance Testing Among Survivors of Early-Stage Breast Cancer J. Clin. Oncol., March 20, 2007; 25(9): 1074 - 1081. [Abstract] [Full Text] [PDF]

				N. L. Liberato, M. Marchetti, and G. Barosi Cost Effectiveness of Adjuvant Trastuzumab in Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer J. Clin. Oncol., February 20, 2007; 25(6): 625 - 633. [Abstract] [Full Text] [PDF]

				C. C. Earle Failing to Plan Is Planning to Fail: Improving the Quality of Care With Survivorship Care Plans J. Clin. Oncol., November 10, 2006; 24(32): 5112 - 5116. [Abstract] [Full Text] [PDF]

				K. C. Oeffinger and M. S. McCabe Models for Delivering Survivorship Care J. Clin. Oncol., November 10, 2006; 24(32): 5117 - 5124. [Abstract] [Full Text] [PDF]

				J. Z. Ayanian and P. B. Jacobsen Enhancing Research on Cancer Survivors J. Clin. Oncol., November 10, 2006; 24(32): 5149 - 5153. [Abstract] [Full Text] [PDF]

				E. Grunfeld Looking Beyond Survival: How Are We Looking at Survivorship? J. Clin. Oncol., November 10, 2006; 24(32): 5166 - 5169. [Abstract] [Full Text] [PDF]

				J. L. Khatcheressian, A. C. Wolff, T. J. Smith, E. Grunfeld, H. B. Muss, V. G. Vogel, F. Halberg, M. R. Somerfield, and N. E. Davidson American Society of Clinical Oncology 2006 Update of the Breast Cancer Follow-Up and Management Guidelines in the Adjuvant Setting J. Clin. Oncol., November 1, 2006; 24(31): 5091 - 5097. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., October 1, 2006; 11(5): 159 - 160. [Full Text] [PDF]

				E. Grunfeld, M. N. Levine, and J. A. Julian In Reply J. Clin. Oncol., August 1, 2006; 24(22): 3711 - 3712. [Full Text] [PDF]

				E. Warner and J. Weinroth Family Physician Versus Specialist Care for Breast Cancer Follow-Up J. Clin. Oncol., August 1, 2006; 24(22): 3710 - 3710. [Full Text] [PDF]

				M. Q. Rosenzweig The Oncology Nurse Practitioner: A Unique Provider for the Follow-Up for Early-Stage Breast Cancer J. Clin. Oncol., August 1, 2006; 24(22): 3710 - 3711. [Full Text] [PDF]

				J. L. Khatcheressian and T. J. Smith Randomized Trial of Long-Term Follow-Up for Early-Stage Breast Cancer: A Comparison of Family Physician Versus Specialist Care J. Clin. Oncol., February 20, 2006; 24(6): 835 - 837. [Full Text] [PDF]