Poster Presentation Cancer Survivorship 2019

Investigating follow up of women with early stage breast cancer (#202)

Yunhui Liang 1 , Amanda Piper 2 , David Speakman 3 , Bruce Mann 3 4 , Jade Johnstone 5 , Karolina Lisy 3 , Michael Jefford 3 4
  1. Australasian College of Health Service Management, Melbourne, VICTORIA, Australia
  2. Cancer Council Victoria, Melbourne, Victoria, Australia
  3. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. University of Melbourne, Melbourne, Victoria, Australia
  5. Latrobe University, Melbourne, Victoria, Australia

Introduction: Cancer Australia recommends a standard follow-up schedule for women with early stage breast cancer (ESBC). A number of guidance documents describe essential elements of survivorship care. This study aimed to describe the frequency and content of follow up visits for survivors of ESBC. Study 1 assessed number of visits to hospital-based specialists; study 2 assessed documentation relating to survivorship visits.

Method: Women with ESBC diagnosed between Jan 2010 and Dec 2015 were identified through hospital databases. Eligible patients had treatment with curative intent (stages I to III) and were disease-free during the examined years of follow up. Follow up appointments were counted during years of follow up, with year 1 of survivorship beginning 12 months from diagnosis. Study 2 assessed the documentation of 20 follow up appointments against a study specific tool developed based on key survivorship dimensions (including assessment for recurrence, persisting side effects, health behaviours, practical issues).

Results: 391 cases were identified for study 1. In survivorship years 1 and 2, 229 cases (70%) were compliant with recommended number of follow up visits (11% greater, 19% fewer). Range of visits were 0-27. Whilst 89 cases (48%) were within the recommended range in years 2 to 5, only 36 cases (27%) were followed at recommended intervals beyond 5 years.

For study part 2, nearly all follow up visits resulted in correspondence with the patient’s GP. New symptoms, physical examination and recent mammogram results were well documented. However, health behaviours and practical needs such as return to work were often missing in documentation.

Conclusions: Many patients have fewer, or a greater number of follow up visits than guideline recommendations. This may result in suboptimal outcomes and / or create additional costs to the patient and healthcare system. In a pilot evaluation, documentation review suggests that some recommended elements of cancer survivorship are not covered consistently in follow up visits.