Breast cancer follow-up: from the perspective of health professionals and patients

Abstract

Increased breast cancer incidence and better survival have raised the number of patients requiring follow-up care. Despite guidelines, there is controversy about appropriate breast cancer follow-up. Therefore, semi-structured interviews were conducted in two hospitals with 23 patients and 18 health professionals (HPs) in order to explore opinions and preferences about the purpose, the duration and frequency of breast cancer follow-up and which examinations should be done, by whom. The transcripts were inductively analysed and coded into pre-identified themes. Patients were followed more intensively than guidelines recommend. HPs mentioned three major reasons; patient preferences, each discipline wanting to observe the patient, and financial incentives. For patients and HPs the most important purpose of follow-up was early detection of new malignancies. A highly valued aspect of follow-up mentioned by HPs was the psychosocial support, which was rarely mentioned by patients. Patient's expectations about the benefits of follow-up and additional examinations were sometimes unrealistic. Patients and HPs were positive about nurse practitioner-led follow-up, but less positive about general practitioner-led follow-up. Important barriers to current guideline adherence were revealed and should be taken into account by implementing new individualised guidelines. Furthermore, patients should be better informed about the benefits of follow-up to prevent unrealistic expectations.

Keywords: breast cancer; follow-up; guidelines; health professional; patient; preferences.