Intensive follow-up for women with breast cancer: review of clinical, economic and patient’s preference domains through evidence to decision framework

Abstract

BackgroundWomen treated for breast cancer are followed-up for monitoring of treatment effectiveness and for detecting recurrences at an early stage. The type of follow-up received may affect women’s reassurance and impact on their quality of life. Anxiety and depression among women with breast cancer has been described, but little is known about how the intensity of the follow-up can affect women’s psychological status. This study was undertaken to evaluate the effects of intensive vs. less-intensive follow-up on different health outcomes, to determine what are women’s preferences and values regarding the follow-up received, and also assess the costs of these different types of follow-up.MethodsA systematic review following standard Cochrane Collaboration methods was carried out to assess the efficacy of intensive follow-up versus non-intensive follow-up in breast cancer patients. Two additional reviews on women’s preferences and economic evidence were also carried out. The search was performed up to January 2016 in: MEDLINE, EMBASE, PDQ, McMaster Health Systems Evidence, CENTRAL, and NHS EED (through The Cochrane Library). The quality of evidence was assessed by GRADE (for quantitative studies) and CerQUAL (for qualitative studies). Several outcomes including mortality, breast cancer recurrences, quality of life, and patient satisfaction were evaluated.ResultsSix randomised trials (corresponding to 3534 women) were included for the evaluation of health outcomes; three studies were included for women’s values and preferences and four for an economic assessment. There is moderate certainty of evidence showing that intensive follow-up, including more frequent diagnostic tests or visits, does not have effects on 5- or 10-year overall mortality and recurrences in women with breast cancer, compared with less intensive follow-up. Regarding women’s preferences and values, there was important variability among studies and within studies (low confidence due to risk of bias and inconsistency). Furthermore, intensive follow-up, as opposed to less intensive follow-up, is not likely to be cost-effective.ConclusionsLess intensive follow-up appears to be justified and can be recommended over intensive follow-up. Resources could thus be mobilised to other aspects of breast cancer care, or other areas of healthcare.Electronic supplementary materialThe online version of this article (10.1186/s12955-017-0779-5) contains supplementary material, which is available to authorized users.

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“…Similarly, imaging for follow-up of patients with early breast cancer and metastatic patients may be delayed if necessary, with tailoring of radiological assessments per symptoms or other suspicion of progression, as clinically assessed-while still preferring telemedicine for non-priority complains and interventions. 21 prIorItIes for breast surgICal onCology Cancer surgery is one of the cancer interventions bringing the greatest benefits for patients with cancer, principally in the curative setting, resulting in gains in cancer survival. 22 The priority-setting framework of breast cancer surgery aims to understand how reasonably and for how long cancer surgery can be delayed, assuring the attainment of the highest standards for quality care delivery.…”

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“…Although current guidelines [4,5,19] and systematic review [9,25] do not recommend routine imaging for patients with breast cancer, real-word practices often involve the use of advanced imaging studies owing to the belief that earlier detection of distant metastasis may lead to improved survival [15,16,26,27]. Moreover, diagnostic studies for distant metastasis may provide emotional support and reassurance to both the physician and patient [6,[28][29][30].…”

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“…There is no evidence that the detection of asymptomatic distant metastases leads to a longer survival 32. Some data indicated that the detection of isolated loco-regional or contra-lateral breast cancer recurrences in patients without symptoms has beneficial impact on survival of breast cancer patients when compared to late symptomatic detection33; however, it was shown that only 40 % of the isolated loco-regional recurrences in asymptomatic patients were detected during routine examination 34.…”