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Meta-Analysis
. 2016 May 27;2016(5):CD001768.
doi: 10.1002/14651858.CD001768.pub3.

Follow-up strategies for women treated for early breast cancer

Ivan Moschetti  1 , Michela Cinquini, Matteo Lambertini, Alessia Levaggi, Alessandro Liberati
Affiliations
Meta-Analysis

Follow-up strategies for women treated for early breast cancer

Ivan Moschetti et al. Cochrane Database Syst Rev. .

Abstract

Background: Follow-up examinations are commonly performed after primary treatment for women with breast cancer. They are used to detect recurrences at an early (asymptomatic) stage. This is an update of a Cochrane review first published in 2000.

Objectives: To assess the effectiveness of different policies of follow-up for distant metastases on mortality, morbidity and quality of life in women treated for stage I, II or III breast cancer.

Search methods: For this 2014 review update, we searched the Cochrane Breast Cancer Group's Specialised Register (4 July 2014), MEDLINE (4 July 2014), Embase (4 July 2014), CENTRAL (2014, Issue 3), the World Health Organization (WHO) International Clinical Trials Registry Platform (4 July 2014) and ClinicalTrials.gov (4 July 2014). References from retrieved articles were also checked.

Selection criteria: All randomised controlled trials (RCTs) assessing the effectiveness of different policies of follow-up after primary treatment were reviewed for inclusion.

Data collection and analysis: Two review authors independently assessed trials for eligibility for inclusion in the review and risk of bias. Data were pooled in an individual patient data meta-analysis for the two RCTs testing the effectiveness of different follow-up schemes. Subgroup analyses were conducted by age, tumour size and lymph node status.

Main results: Since 2000, one new trial has been published; the updated review now includes five RCTs involving 4023 women with breast cancer (clinical stage I, II or III).Two trials involving 2563 women compared follow-up based on clinical visits and mammography with a more intensive scheme including radiological and laboratory tests. After pooling the data, no significant differences in overall survival (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.84 to 1.15, two studies, 2563 participants, high-quality evidence), or disease-free survival (HR 0.84, 95% CI 0.71 to 1.00, two studies, 2563 participants, low-quality evidence) emerged. No differences in overall survival and disease-free survival emerged in subgroup analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for one trial of these trials, and no significant differences in overall survival were found. No difference was noted in quality of life measures (one study, 639 participants, high-quality evidence).The new included trial, together with a previously included trial involving 1264 women compared follow-up performed by a hospital-based specialist versus follow-up performed by general practitioners. No significant differences were noted in overall survival (HR 1.07, 95% CI 0.64 to 1.78, one study, 968 participants, moderate-quality evidence), time to detection of recurrence (HR 1.06, 95% CI 0.76 to 1.47, two studies, 1264 participants, moderate-quality evidence), and quality of life (one study, 356 participants, high-quality evidence). Patient satisfaction was greater among patients treated by general practitioners. One RCT involving 196 women compared regularly scheduled follow-up visits versus less frequent visits restricted to the time of mammography. No significant differences emerged in interim use of telephone and frequency of general practitioners's consultations.

Authors' conclusions: This updated review of RCTs conducted almost 20 years ago suggests that follow-up programs based on regular physical examinations and yearly mammography alone are as effective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life.In two RCTs, follow-up care performed by trained and not trained general practitioners working in an organised practice setting had comparable effectiveness to that delivered by hospital-based specialists in terms of overall survival, recurrence detection, and quality of life.

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Conflict of interest statement

Roldano Fossati (RF) and Alessandro Liberati (AL) were members of the Steering Group of the GIVIO study included in this review and wrote several review articles of the effect of follow‐up care. The GIVIO trial (of which RF and AL were authors) was originally partially supported by a educational grant from Astra Zeneca Italia. No specific funding was available for the original conduct and update of this review. Ivan Moschetti, Michela Cinquini, Alessia Levaggi and Laura Coe do not have any conflict of interests.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 1 Overall survival.
1.2
1.2. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 2 Overall survival by age.
1.3
1.3. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 3 Overall survival by tumour size.
1.4
1.4. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 4 Overall survival by lymphonodal status.
1.5
1.5. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 5 Overall survival 5 years.
1.6
1.6. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 6 Disease‐free survival.
1.7
1.7. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 7 Disease‐free survival by age.
1.8
1.8. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 8 Disease‐free survival by tumour size.
1.9
1.9. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 9 Disease‐free survival by lymphonodal status.
1.10
1.10. Analysis
Comparison 1 Non‐intensive follow‐up vs intensive follow‐up, Outcome 10 number of metastasis detected in an asymptomatic way.
2.1
2.1. Analysis
Comparison 2 Centralised vs decentralised follow‐up, Outcome 1 Overall survival.
2.2
2.2. Analysis
Comparison 2 Centralised vs decentralised follow‐up, Outcome 2 Disease‐free survival.
See this image and copyright information in PMC

Update of

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