GENERAL PRACTICE ROUTINE FOLLOW UP OF BREAST CANCER IN PRIMARY CARE: RANDOMIZED TRIAL

ARTIGO COMENTADO / COMMENTED ARTICLE

A RTIGO C OMENTADO

Commented Article

Resumo do Artigo
G ENERAL P RACTICE
R OUTINE F OLLOW U P OF B REAST
C ANCER IN P RIMARY C ARE :
R ANDOMIZED T RIAL
Eva Grunfeld1, David Mant2,
Patricia Yudkin3, Ruth AdewuyiDalton4, David Cole5, Jill Stewart6,
Ray Fitzpatrick7, Martin Vessey8

Abstract
Objective – To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice.
Design – Randomized controlled trial with
18 month follow up in which women received routine follow up either in hospital or in general practice. Subjects and setting – 296 women with breast cancer in remission receiving regular follow up care at district general hospitals in England.
Main outcome measures – Time between first presentation of symptoms to confirmation of recurrence; quality of life measured by specific dimensions of the SF-36 schedule, the EORTC

University of Oxford, Department of Public Health and Primary Care,
Radcliffe Infirmary, Oxford OX2 6HE
1- Research fellow
2- Clinical lecturer in primary care
3- Statistician
4- Research assistant
7- University lecturer in medical sociology
8- Professor of public health

symptom scale, and hospital anxiety and depression scale.
Results – Most recurrences (18/26, 69%) presented as interval events, and almost half (7/
16, 44%) of the recurrences in the hospital group presented first to general practice. The median time to hospital confirmation of recurrence was
21 days in the hospital group (range 1-376 days) and 22 days in the general practice group (range
4-64). The differences between groups in the change in SF-36 mean scores from baseline were small: - 1.8 (95% confidence interval – 7.2 to
3.5) for social functioning, 0.5 (- 4.1 to 5.1) for mental health, and 0.6 (- 3.6 to 4.8) for general health perception.