665

Background: Breast cancer patients usually receive follow-up in cancer centers. From the results of preliminary research (Grunfeld, BMJ 1996;313:665), we hypothesized that routine follow-up in primary care is a safe and acceptable alternative to follow-up in specialist care. Methods: Women with early stage breast cancer who had completed adjuvant therapy (patients may have continued on adjuvant hormonal therapy), who were disease free and between 9 and 15 months after diagnosis, were allocated to receive follow-up in a cancer center according to usual practice (CC arm) or follow-up from their family physician (FP arm). Patients in the FP arm were referred back to the cancer center if diagnosed with recurrence or a new primary cancer. The primary outcome was a comparison of the rate of ‘serious clinical events’ (SCE) defined as any one of the following: spinal cord compression, pathological fractures, hypercalcaemia, uncontrolled local recurrence, brachial plexopathy, or poor functional status (Karnofsky ≤ 70). Secondary outcome was quality of life (QL). Results: 483 patients were allocated to the FP arm and 485 to the CC arm. Median follow-up was 3.5 years. The average age was 61 years; 69% were node negative; 73% had a lumpectomy; 77% had radiation. The FP arm had 54 (11.2%) recurrences and 29 deaths (6.0%). The CC arm had 63 (13.0%) recurrences and 30 (6.2%) deaths. In the FP arm 16 patients (3.3%) experienced a SCE compared to 18 (3.7%) in the CC arm (0.4% difference; 95%CI –2.02 to +2.83). There were no differences between groups in QL as measured by the SF36 Physical and Mental Component Scales and the HADS anxiety and depression scales. Conclusions: Primary care follow-up of breast cancer patients is a safe and acceptable alternative to specialist follow-up.

No significant financial relationships to disclose.