Follow-up in breast cancer clinics: reassuring for patients rather than detecting recurrence

Abstract

Despite evidence that questions the value of routine hospital follow-up after treatment for breast cancer, there is little evidence to indicate what actually takes place during follow-up consultations and whether patients benefit from the experience. This study aimed to investigate the nature and content of hospital follow-up visits following treatment for breast cancer using a mixed methods approach. Methods included direct observation and audio-recording of 104 consultations, semi-structured interviews with 14 health care professionals (HCP) involved in follow-up service provision and a patient survey. Consultations were focused on detection of recurrent disease by clinical examination, despite this being a rare event. HCPs' style of interaction could foster the illusion that follow-up visits were intended to detect recurrence. Consultations were generally of brief duration (mean 6 min) and were overwhelmingly optimistic, although patients gained reassurance from minimal interaction. Few opportunities were available to meet information and psychosocial needs. The costly system of follow-up currently in operation is historically rather than evidence based, and subject to increasing demands and limited resources. Alternative approaches are needed that address the diversity of patients' needs rather than searching for recurrent disease. However, when formulating policy and evaluating new approaches, patients' expectations of what constitutes follow-up care need to be clearly addressed.