Montgomery D A, Krupa K, Cooke T G
University Department of Surgery, Level 2, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Br J Cancer. 2007 Jun 4;96(11):1625-32. doi: 10.1038/sj.bjc.6603771. Epub 2007 May 8.
Regular clinical follow up after breast cancer is a common practice. Evidence from retrospective reviews casts doubt on the efficacy of this practice and the various guidelines for follow up show little concordance. Our aim was to investigate what alternative follow-up methods (including reduced frequency of visits) have been subjected to controlled trial and to establish what evidence exists from controlled trials to advise the guidelines. The study involved systematic review of the literature using MEDLINE, Embase, CancerLit, Web of Sciences and EBM reviews as data sources. Methods included reviewing all randomised controlled trials comparing different follow-up frequencies or comparing an alternative method with clinical follow up after breast cancer. All outcome measures addressed in the trials were analysed. Two trials compared frequency of traditional follow up. Five trials assessed alternative methods. All were of inadequate power or duration to establish ideal frequency of clinic visits or safety of alternative follow-up methods. Alternative follow up had no detrimental effect on satisfaction or outcome. Few trials have been conducted, all of which are underpowered to establish safety of reducing or replacing clinic visits. Alternative methods of follow up are acceptable to patients and may be associated with other benefits. Larger trials are required.
乳腺癌后的定期临床随访是一种常见做法。回顾性综述的证据对这种做法的有效性提出了质疑，而且各种随访指南之间几乎没有一致性。我们的目的是调查哪些替代随访方法（包括减少就诊频率）已经进行了对照试验，并确定对照试验中有哪些证据可为指南提供建议。该研究包括使用MEDLINE、Embase、CancerLit、Web of Sciences和循证医学综述作为数据源对文献进行系统综述。方法包括回顾所有比较不同随访频率或比较替代方法与乳腺癌后临床随访的随机对照试验。对试验中涉及的所有结局指标进行了分析。两项试验比较了传统随访的频率。五项试验评估了替代方法。所有这些试验的效力或持续时间都不足以确定理想的就诊频率或替代随访方法的安全性。替代随访对满意度或结局没有不利影响。进行的试验很少，所有这些试验的效力都不足以确定减少或取代就诊的安全性。替代随访方法为患者所接受，并且可能有其他益处。需要进行更大规模的试验。
