Questioning specialists’ attitudes to breast cancer follow-up in primary care

Abstract

Specialists favour a risk adjusted discharge strategy and increased oncology infrastructure in primary care.

Discharge of breast cancer patients to primary care at the end of hospital follow-up: A cross-sectional survey

“…This is in accordance with previous studies suggesting that specialists have difficulty discharging patients to primary care. 3,9 We also found that only 31% of the GPs used the current breast cancer guideline from the Dutch College of General Practitioners during the follow-up of their patient. Previous studies have shown that clinical guidelines in general practice with low compliance rates were those requiring new knowledge and skills, not easy to follow, not compatible with existing norms and values Table 3 Personal and practice characteristics associated with general practitioners' (GPs') willingness to accept exclusive responsibility for routine breast cancer follow-up at an earlier stage.…”

“…1,2 Several guidelines exist for follow-up. [3][4][5] In the Netherlands, the current breast cancer guidelines recommend hospital follow-up for 5 years, including yearly mammography. After these 5 years, patients aged >60 years, and treated with breast-conserving therapy, are discharged to their general practitioner (GP) for yearly physical examination and two-yearly mammography.…”

“…[6][7][8] Previous studies have shown that breast cancer specialists follow patients longer than the guidelines prescribe, due to factors such as younger age, higher breast cancer stage, family history, treatment-related morbidity and on-going hormone therapy, 3,9 indicating that specialists have difficulty discharging patients to primary care. 9 This difficulty may be also explained by patients' preference for hospital follow-up and concerns among patients [10][11][12] and specialists 3,13,14 about the level of oncology knowledge and skills of primary care physicians. It is unknown if Dutch breast cancer patients aged >60, and treated with breast-conserving therapy, are actually discharged to their GP after 5 years of hospital follow-up.…”

Automated telephone follow-up after breast cancer: an acceptability and feasibility pilot study

“…There is reluctance on the part of hospital clinicians to implement these guidelines (Donnelly et al, 2007). Although breast surgeons and oncologists recognise the benefit of reduced clinic workload which comes with discharging patients to general practice, anxiety over perceived lack of GP training and experience in oncology and potential loss of patient outcome data leave them reluctant to follow NICE guidance (Donnelly et al, 2007).…”

Models of Care for Early-Stage Breast Cancer in Canada

“…Although many specialists favour transferring care of ebc patients, on a risk-adjusted basis, to a primary care physician 3 , and although primary care physicians are willing to play a greater role in follow-up care 4,31 , consideration of the patient perspective is also important 7 . Recently, we conducted 3 online surveys in Canada to determine the views of oncologists, primary care physicians, and patients on the well follow-up care of patients with ebc.…”