Screening for recurrent breast cancer--its effectiveness and prognostic value.

Tomin, R; Donegan, William L.

doi:10.1200/jco.1987.5.1.62

Cited by 118 publications

(45 citation statements)

References 9 publications

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“…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).…”

supporting

confidence: 58%

Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation

et al. 1999

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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...

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supporting

confidence: 58%

Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation

et al. 1999

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“…One of the main prognostic discriminants is the site and number of metastases, which makes it difficult to compare (inter-) national data deriving from different hospitals. Nevertheless, median post-recurrence survival is mostly in the range of 18-24 months (Powles et al, 1980;Patel et al, 1986;Tomin & Donegan, 1987;Perez et al, 1990;Dixon et al, 1991), which strongly resembles our data (20.3 mo). Almost 60% of the women in the three hospitals had received radiation treatment for advanced disease.…”

Section: Discussionsupporting

confidence: 80%

Advanced breast cancer and its prevention by screening

Bm²,

Jc³

et al. 1992

Br J Cancer

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Summary In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources. A random sample of 60 female cases from computerised registries of two cancer centres and a sample of 20 cases from a non-computerised hospital registry was taken. A total of 68 patient files were sufficiently documented. A woman with advanced breast cancer is estimated to have a 39% loss in utility compared to a healthy woman (range 27-45%). Hormonal treatment is the main modality during 14 and chemotherapy during 4 months. Total medical cost from diagnosis of advanced disease until death amounts to 17,100 US dollars, or 21,000 when including extramural cost.The effect of breast cancer screening by preventing the occurrence of advanced disease is quantified. The resulting gain in quality of life contributes 70% of the total gain in quality of life. In the long run, almost half of the annual cost of screening will be offset by savings in the cost for advanced disease. Only the changes in palliative surgery and/or radiotherapy will be small in contrast to primary treatment changes. Besides the mortality reduction, screening is justified by the improvements in quality of life and cost savings for women prevented from reaching advanced disease.

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“…The value of clinical laboratory tests in the follow-up of breast cancer patients has been questioned due to their insensitivity and nonspecificity (Ormiston et al, 1985;Tomin & Donegan, 1987). CEA has been the only tumour marker suitable in some cases for the monitoring of treatment in advanced breast cancer (Tormey & Waalkes, 1978;Mughal et al, 1983).…”

mentioning

confidence: 99%