Greenfield D M, Absolom K, Eiser C, Walters S J, Michel G, Hancock B W, Snowden J A, Coleman R E
Academic Unit of Clinical Oncology, Weston Park Hospital, WhithamRoad, Sheffield S10 2SJ, UK.
Br J Cancer. 2009 Aug 18;101(4):568-74. doi: 10.1038/sj.bjc.6605160. Epub 2009 Jul 28.
Evidence for the efficacy of late effects surveillance in adult cancer survivors is lacking and there is little agreement among clinicians on appropriate follow-up care.
We report the views of both cancer experts and general practitioners (GPs) on long-term follow-up provision for cancer survivors, focussing on the 18-45 years age group. A total of 421 cancer experts (36% haematologists, 33% oncologists, 18% surgeons, 10% nurses, 2% other) and 54 GPs responded to a structured online survey. Reasons for follow-up care (clinical or supportive); advantages and disadvantages of follow-up in primary care; current practice; and resources required for a quality follow-up service were assessed.
Clinicians valued clinical reasons for follow-up more highly than supportive reasons (P<0.001). Learning more about late effects and checking for cancer recurrence were rated as the most important reasons for follow-up by cancer experts and GPs. A total of 85% of cancer specialists hold follow-up consultations alongside patients on active treatment. Cancer experts agreed that primary care follow-up would increase their availability for acute oncological care, but reduce information on late effects. The most important resource to provide a quality follow-up service was specialist nursing support (91%).
Follow-up guidelines that include late effects surveillance are needed. Where and who should deliver this care requires further debate.
缺乏关于成年癌症幸存者迟发效应监测有效性的证据，临床医生对于适当的后续护理也几乎没有达成共识。
我们报告了癌症专家和全科医生（GP）对于癌症幸存者长期后续护理的看法，重点关注18至45岁年龄组。共有421名癌症专家（36%为血液科医生，33%为肿瘤内科医生，18%为外科医生，10%为护士，2%为其他）和54名全科医生回应了一项结构化在线调查。评估了后续护理的原因（临床或支持性）；初级保健中后续护理的优缺点；当前实践；以及优质后续服务所需的资源。
临床医生更看重后续护理的临床原因而非支持性原因（P<0.001）。了解更多迟发效应和检查癌症复发被癌症专家和全科医生评为后续护理的最重要原因。共有85%的癌症专科医生在患者接受积极治疗时同时进行后续咨询。癌症专家一致认为，初级保健后续护理会增加他们提供急性肿瘤护理的可及性，但会减少关于迟发效应的信息。提供优质后续服务最重要的资源是专科护理支持（91%）。
需要包含迟发效应监测的后续护理指南。由何处及何人提供此类护理仍需进一步讨论。
