1586 ORAL Hospital follow-up for breast cancer: the search for recurrent disease

Abstract

Background: Following completion of breast cancer treatment, patients are traditionally asked to return to hospital outpatient clinics for 'follow-up'. Recent policy documents question the value of this traditional approach and the impact of routine surveillance procedures on survival and quality of life. As a result, reductions in duration of follow-up have been proposed. However, there is little research into the nature and content of follow-up care. What happens during follow-up consultations? This presentation reports on a study that examined the nature and content of hospital follow-up for women treated for breast cancer in a UK hospital. Methods: This study primarily took an ethnographic approach that involved observation, recording and timing of 104 consultations between patients and health professionals. In addition, in-depth interviews were conducted with medical and nursing staff involved in the provision of follow-up care for women with breast cancer (n = 14). Patients who had been observed were asked to complete a questionnaire about their clinic visit. Results: Hospital follow-up was focused on searching for recurrent disease (through clinical examination and routine mammograms) and providing reassurance that cancer had not returned. However, no recurrences were detected during the 104 consultations observed in this study. Health professionals did not expect to find recurrences on clinical examination but patients perceived that the clinical examination was the primary means of detecting recurrent disease. Consultations were brief (mean 6 mins), although patients over-estimated duration. There was little opportunity for patients to discuss information needs or psycho-social concerns as clinics were heavily focused on medical signs and symptoms of recurrence. Conclusion: The traditional approach to follow-up care for women with breast cancer is historically based and does not empower patients to take