General practice follow up of women with breast cancer in remission is not associated with increase in time to diagnosis, increase in anxiety, or deterioration in health 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.

After completing primary treatment, it is standard practice in most countries for breast cancer patients to be followed in specialist outpatient clinics during the disease-free interval. This practice of post-treatment surveillance has recently come under close scrutiny (Dewar, 1995;Donegan, 1995;Loprinzi, 1995; Breast Cancer Surveillance Expert Panel, 1997). Studies to evaluate its effectiveness have used a Ôless intensiveÕ specialist follow-up regimen as the comparator (GIVIO Investigators, 1994;Rosselli Del Turco et al, 1994). No previous studies have evaluated prospectively the cost effectiveness of this practice of long-term follow-up of breast cancer patients.We conducted a randomized controlled trial (RCT) comparing specialist follow-up with follow-up by the patientÕs own general practitioner (Grunfeld et al, 1996). The results showed no increase in delay in diagnosing recurrence and reinitiating specialist care as a result of primary care follow-up. As has been reported in previous studies (Clark and Morris, 1981;Hughes, 1985;Tomin and Donegan, 1987;McWhinney et al, 1990;Worster et al, 1995), the results of the RCT (Grunfeld et al, 1996) showed that most recurrences are detected in the interval between regularly scheduled follow-up appointments, and many are presented to the general practitioner irrespective of the formal follow-up arrangements. The results also showed no increase in anxiety or deterioration in health-related quality of life (HRQOL) (Grunfeld et al, 1996). We report here the results of the economic evaluation to assess the relative costs of the two alternative schemes of followup that was conducted concurrent with the RCT. Because the RCT showed no important differences in the primary clinical outcomes, the form of economic evaluation was cost minimization whereby the two schemes are examined for the least costly alternative (Drummond et al, 1997). PARTICIPANTS AND METHODS Participants and methods for the RCTParticipants were 296 women with breast cancer in remission receiving regular follow-up at two district general hospitals in England. These women were taking part in an RCT to evaluate a primary-care-based system of routine breast cancer follow-up, whereby they were randomized to one of two groups: continued routine follow-up in hospital outpatient clinics according to usual practice (hospital group) or routine follow-up from their own general practitioner (general practice group). Ethical approval to conduct the study was obtained from the local research ethics committees. The recommended follow-up regimen was the same for women in both groups and involved periodic physician visits for a breast cancer check-up, routine surveillance mammograms (the frequency depended on initial treatment and age), and diagnostic testing only if clinically indicated. A full description of study participants, study methods and results of the primary outcomes of time to diagnosis of recurrence and HRQOL have been reported previously (Grunfeld et al, 1996). Data collection for economic evaluation was an...

Can patient views, obtained through patient focus groups, make a contribution to the design of clinical trials? This paper describes the use of patient focus groups as a method of gaining information for the development of a randomised trial looking at community versus hospital care in breast cancer follow‐up. Focus groups were used as a method of obtaining qualitative data. Quick and easy access to patients was obtained through a local cancer support group network. Initial responses from the focus group participants appeared to be unfavourable to the protocol. In all, more than five issues were raised which might lead to reluctance to cooperate in the trial. Participants identified key issues related to their follow‐up. Changes were made to the protocol addressing the issues raised. It is suggested that where trials require informed consent, using focus groups to find out patients' perceptions at the initial stage may well save time and money, increase participation levels and lead to better outcomes.

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