Cancer Centre, University Hospital Coventry and Warwick, Coventry, UK.
Clin Oncol (R Coll Radiol). 2010 Mar;22(2):91-6. doi: 10.1016/j.clon.2009.11.008. Epub 2010 Jan 6.
The incidence and prevalence of breast cancer is increasing, and survival rates continue to climb, placing increasing demands on clinic time. In the modern health service, the value of routine follow-up has been questioned, as there is a very low rate of detection of asymptomatic recurrences in such clinics. The National Institute for Health and Clinical Excellence has recommended potential discharge after the completion of adjuvant treatment. However, there is more to follow-up than the detection of recurrence. This aim of this study was to determine the level and type of intervention occurring within a dedicated hospital breast cancer follow-up clinic, taking into account recent developments in management. We also reviewed the role of community-based breast cancer follow-up as an alternative setting to the hospital.
All patients attending a dedicated breast cancer follow-up clinic within a hospital setting under the care of a single oncologist over a 7 month period were prospectively studied. Information regarding tumour characteristics, in addition to any form of investigation, intervention and trial recruitment, was recorded for 598 patients.
A breast cancer-relevant intervention was carried out in 50% of patients. Forty-seven patients (7.9%) had their breast medication changed, 81 (13.5%) were investigated for suspected recurrence and 44 (7.4%) were enrolled into a clinical trial. Fourteen (2.3%) patients were referred to another specialty; in total, 115 (19.2%) further investigations were carried out related to the disease or treatment.
A significant number of interventions were undertaken from the clinic. A large proportion of these could be co-ordinated from primary care, if adequate guidelines are in place. However, rapid advances in breast cancer management should be considered, and cost-effectiveness needs to be studied before making strong recommendations as to where breast cancer follow-up is best managed.
乳腺癌的发病率和患病率正在上升，生存率持续攀升，这对诊所时间提出了越来越高的要求。在现代医疗服务中，常规随访的价值受到了质疑，因为在这些诊所中，无症状复发的检出率非常低。国家卫生与临床卓越研究所建议在辅助治疗完成后可以考虑潜在的出院。然而，随访的目的不仅仅是发现复发。本研究旨在确定在专门的医院乳腺癌随访诊所中进行的干预水平和类型，同时考虑到管理方面的最新进展。我们还回顾了社区为基础的乳腺癌随访作为医院替代设置的作用。
在 7 个月的时间内，对在医院环境下由一名肿瘤专家负责的专门乳腺癌随访诊所中就诊的所有患者进行了前瞻性研究。记录了 598 名患者的肿瘤特征信息，以及任何形式的调查、干预和试验招募。
50%的患者接受了与乳腺癌相关的干预措施。47 名患者（7.9%）改变了乳腺癌药物治疗，81 名患者（13.5%）因疑似复发而接受了检查，44 名患者（7.4%）参加了临床试验。14 名患者（2.3%）被转诊至其他专科；总共进行了 115 项（19.2%）与疾病或治疗相关的进一步检查。
该诊所进行了大量的干预措施。如果制定了充分的指南，其中很大一部分可以由初级保健协调进行。然而，应该考虑到乳腺癌管理方面的快速进展，并需要对成本效益进行研究，然后才能就乳腺癌随访的最佳管理地点提出强有力的建议。
