Follow-up for breast cancer - the patients' view

Background: International and national guidelines (S3 guideline) for the surveillance of post-treatment breast cancer patients recommend a clinical follow-up including routine history and physical examination and regular mammograms. The practice of a clinical follow-up has been often discussed, but has been proven not to be inferior when compared to an intensified follow-up in randomized trials. Patients and Methods: The present manuscript reports the patients' view on the basis of a survey including 2000 patients with a history of breast cancer. Results: A total of 452 patients (22.6%) answered the questionnaire. The median age was 62 years (range 23-85 years). More than 80% of the patients were disease-free at the time of the survey. The need for surveillance was affirmed by the majority of patients (>95%), and one third stated that there was a need for more technical efforts during follow-up. In contrast to the follow-up guidelines, the results of the present survey indicated that most of the regularly scheduled follow-up visits were expanded using extensive laboratory and imaging procedures. Conclusion: This survey shows that the majority of physicians obviously do not accept the present follow-up guidelines. A new surveillance study investigating the efficacy of an intensified surveillance based on the improved possibilities of modern diagnostics and endocrine, immunotherapeutic, chemotherapeutic and interventional treatment options is warranted

The Reality in the Surveillance of Breast Cancer Survivors—Results of a Patient Survey

Background: International guidelines for the surveillance of breast cancer patients recommend a minimized clinical follow-up including routine history and physical examination and regularly scheduled mammograms. However, the abandonment of scheduled follow-up examinations in breast cancer survivors remains a contradiction to established follow-up guidelines for other solid tumours.Patients and Methods: We report the patients’ view on the basis of a survey performed in two separate geographical areas in Germany. The questionnaires were sent out to 2.658 patients with a history of breast cancer.Results: A total of 801 patients (30.1%) responded to the questionnaire. The results of the survey can be summarized in two major categories: First, necessity for surveillance was affi rmed by a majority (>95%), and 47.8% of the organized patients answered that there was a need for more intensive diagnostic effort during follow-up. The main expectation from an intensified follow-up was the increased feeling of security as expressed by >80% of the women. Second, the present survey indicates that most of the regularly scheduled follow-up visits were expanded using extensive laboratory and imaging procedures exceeding the quantity of examinations recommended in the present follow-up guidelines.Conclusion: Despite the fact that only one third of the patients responded to the questionnaire, the survey indicates that a majority of physicians who treated these patients still do not accept the present follow-up guidelines. To some extent this may be explained by the observation that patients and possibly also their doctors trust that intensified follow-up increases diagnostic security and survival. Since considerable changes in the treatment options of breast cancer have been made during the last decades a new trial of investigations in follow-up is warranted

Follow-Up for Breast Cancer – the Patients’ View

Background: International and national guidelines (S3 guideline) for the surveillance of post-treatment breast cancer patients recommend a clinical follow-up including routine history and physical examination and regular mammograms. The practice of a clinical follow-up has been often discussed, but has been proven not to be inferior when compared to an intensified follow-up in randomized trials. Patients and Methods: The present manuscript reports the patients’ view on the basis of a survey including 2000 patients with a history of breast cancer. Results: A total of 452 patients (22.6%) answered the questionnaire. The median age was 62 years (range 23–85 years). More than 80% of the patients were disease- free at the time of the survey. The need for surveillance was affirmed by the majority of patients (>95%), and one third stated that there was a need for more technical efforts during follow-up. In contrast to the follow-up guidelines, the results of the present survey indicated that most of the regularly scheduled follow-up visits were expanded using extensive laboratory and imaging procedures. Conclusion: This survey shows that the majority of physicians obviously do not accept the present follow-up guidelines. A new surveillance study investigating the efficacy of an intensified surveillance based on the improved possibilities of modern diagnostics and endocrine, immunotherapeutic, chemotherapeutic and interventional treatment options is warranted.Hintergrund: Internationale und nationale Leitlinien (S3- Leitlinie) empfehlen eine rein symptomorientierte Nachsorge, die hinsichtlich der apparativen Diagnostik allein durch eine regelmäßige Mammographie erweitert wird. Allerdings stößt diese Praxis, die in randomisierten Untersuchungen einer intensivierten Nachsorge gleichwertig war, bei den Betroffenen immer wieder auf Unverständnis. Patientinnen und Methoden: Die vorliegende Untersuchung zeigt die Sichtweise der Betroffenen basierend auf den Ergebnissen einer Umfrage bei 2000 Patientinnen mit anamnestisch bekanntem Mammakarzinom. Ergebnisse: Insgesamt beantworteten 452 Patientinnen (22,6%) den Fragebogen. Das mediane Alter der Befragten betrug 62 Jahre (23–85 Jahre). Mehr als 80% der Patientinnen waren zum Befragungszeitpunkt krankheitsfrei. Die Notwendigkeit der Nachsorge wurde von der Mehrheit der Patientinnen bejaht (>95%), allerdings wünschten knapp ein Drittel der Befragten eine mehr apparativ ausgerichtete Nachsorge. Im Gegensatz zu den Richtlinien zeigt diese Umfrage, dass die gegenwärtig durchgeführten Nachsorgeuntersuchungen mit teils ausgiebigen Laboruntersuchungen und bildgebenden Verfahren erweitert werden. Schlussfolgerung: Diese Umfrage offenbart eine klare Diskrepanz zwischen den Empfehlungen und den tatsächlich durchgeführten Nachsorgeuntersuchungen. Eine neue Nachsorgestudie, die den Nutzen einer intensivierten Nachsorge vor dem Hintergrund innovativer Diagnostik- und Therapieverfahren (z.B. Endokrinologie, Immuntherapie, Chemotherapie) untersucht, ist notwendig