How do I follow patients with early breast cancer after completing adjuvant therapy

Abstract

With improvements in the detection and treatment of breast cancer, more women are surviving after diagnosis. Patients who complete adjuvant therapy require ongoing follow-up to manage toxicities, to detect recurrences early, and to provide ongoing physical and psychosocial support. Routine surveillance should be implemented, with attention to educating patients about symptoms of recurrence, such as weight loss, cough, and bone pain. An intensive surveillance strategy with the routine use of laboratory and radiographic studies does not improve outcomes and raises the cost of follow-up. Patients should have annual mammograms in conjunction with physical exam and history at appropriate intervals that increase the farther out patients are from treatment. Attention also should be focused on other routine health maintenance and cancer screening, such as colonoscopy, gynecologic examinations, and bone health/DEXA scans. In the early posttreatment period, medical oncologists are best equipped to follow these patients. However, as women live longer after a breast cancer diagnosis and treatment, transitioning care to a primary care physician or nurse practitioner is appropriate, provided these practitioners are educated about late treatment effects and managing side effects of treatment, which may continue as long as a decade. A multidisciplinary follow-up strategy with excellent communication between providers can ensure safe, convenient, and quality care to the growing population of breast cancer survivors. As the treatment of breast cancer evolves into personalized strategies based on the biologic characteristics of individual tumors, future studies will be needed to determine if a single surveillance strategy is sufficient or if individualized surveillance based on risk can improve outcomes and costs of long-term follow-up care.