Report in English with a Dutch summary (KCE reports 63A)

128 Breast Cancer KCE reports 63
Surveillance of breast cancer patients.
Study ID Ref Search
date
Rojas MP et al [264] 2004 Women treated for
stage I, II and III
breast cancer
Grunfeld E 2006 [265] NA Women with earlystage
breast cancer
who had completed
adjuvant
chemotherapy,
radiotherapy, or
both at least 3
months previously;
who were disease
free; and who were
between 9 and 15
months after
Population Intervention Ouctomes Results Comments Study
type
diagnosis
Kokko R 2005 [266] NA Breast cancer
patients with
localized disease
after primary
treatment
Follow-up after primary
treatment
Follow-up either in a
cancer center according
to usual practice (CC
group) (n = 485) or from
their own family
physician (FP group) (n =
483)
Visit every 3 rd (frequent
arms A, B) vs. 6 th
(infrequent arms C, D)
month and diagnostic
tests routinely (routine
arms A, C) vs. only when
clinically indicated (no
routine arms B, D).
A: n = 125
B: n = 114
C: n = 118
D: n = 115
Recurrencerelated
serious
clinical event
QoL
Follow-up based on clinical visits and mammography
vs. a more intensive scheme including radiological and
laboratory tests (2 RCTs): no significant differences in
overall survival (HR 0.96, 95%CI 0.80 to 1.15) or
disease-free survival (HR 0.84, 95%CI 0.71 to 1.00).
Follow-up performed by a hospital-based specialist vs.
follow-up performed by general practitioners (1 RCT):
no significant differences in time to detection of
recurrence and quality of life. Patient satisfaction was
greater among patients treated by general
practitioners.
Regularly scheduled follow-up visits vs. less frequent
visits restricted to the time of mammography (1 RCT):
no significant differences in interim use of telephone
and frequency of GP’s consultations.
In the FP group, there were 54 recurrences (11.2%)
and 29 deaths (6.0%). In the CC group, there were 64
recurrences (13.2%) and 30 deaths (6.2%). In the FP
group, 17 patients (3.5%) compared with 18 patients
(3.7%) in the CC group experienced an SCE (0.19%
difference; 95%CI 2.26% to 2.65%). No statistically
significant differences were detected between groups
on any of the HRQL questionnaires.
Neither the frequency of visits nor the intensity of
diagnostic examinations had any effect on disease-free
or overall survival of patients. The total costs of
follow-up, however, were different in the four
followup schedules and varied between arms per
patient from 1050 to 2269 € and per detected
recurrence from 4166 to 9149 €. Outpatient visits
every third month compared to every sixth month and
routine examinations in the followup of asymptomatic
primary breast cancer patients do not improve patient
disease-free or overall survival, but increase the costs
of follow-up 2.2 times.
4 RCTs included
(3055 women)
SR High
RCT High
RCT High
Level of
evidence