Randomized trial of long-term follow-up for early-stage breast cancer: A comparison of family physician versus specialist care
Randomized trial of long-term follow-up for early-stage breast cancer: A comparison of family physician versus specialist care
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DOI：
10.1200/jco.2005.03.2235
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发表时间：
2006-02-20
影响因子：
45.3
通讯作者：
Whelan, T
中科院分区：
文献类型：
--
作者：
Grunfeld, E;Levine, MN;Whelan, T
目的大多数乳腺癌患者在早期诊断，80%以上的患者将成为长期生存者。常规随访标志着从强化治疗到存活的过渡。通常的做法是在专科诊所进行例行跟进。这项研究验证了这样的假设，即由患者的家庭医生进行随访是一种安全和可接受的替代专家随访的方法。患者和方法进行了一项多中心、随机、对照试验，涉及968名早期乳腺癌患者，他们已经完成辅助治疗，没有疾病，并且在诊断后9到15个月之间。患者可能继续接受辅助性激素治疗。患者被随机分配到癌症中心按惯例进行随访(CC组)或由自己的家庭医生进行随访(FP组)。主要结果是复发相关严重临床事件(SCES)的发生率。结果FP组复发54例(11.2%)，死亡29例(6.0%)。CC组复发(3.2%)，死亡30例(6.2%)。在FP组中，17例(3.5%)与CC组的18例(3.7%)发生SCE(0.19%差异；95%CI，-2.26%至2.65%)。结论家庭医生可以为乳腺癌患者提供随访，而不用担心重要的复发相关的SCES会发生得更频繁，或者HRQL会受到负面影响。
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 (3.2%) 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.