Breast cancer follow-up: could primary care be the right venue?

To identify the elements of a follow-up protocol for treated breast cancer patients in primary care with reference to key stakeholders in one region of the UK.

Stage 1: a survey of 100 consecutive hospital records relating to patients treated for primary breast cancer. The most common problems managed at follow-up and the type and frequency of resources used were identified. Stage 2: focus groups with stakeholders identifying potential barriers to follow-up of breast cancer patients in primary care after successful therapy. Stage 3: a nominal group outlined the elements of a follow-up protocol in primary care.

The most frequently recorded problems in 702 patient years of follow-up were anxiety, unrelated medical problems and joint pain. Anxiety and depression tend to present relatively soon and are often enduring whereas concomitant medical problems also present later. Health care professionals considered patients difficult to manage because symptoms of recurrence require investigation for absolute reassurance of the symptomatic patient. However, investigations other than mammograms were seldom necessary.

A multidisciplinary panel identified attention to the psychosocial sequelea of breast cancer as a vital aspect of follow-up. Patients and their partners are preoccupied with a fear of recurrence. This may manifest in a variety of guises including mental health problems. These can be addressed in primary care especially with the support of counsellors, with teamwork and agreed protocols for referral back to specialists when indicated.