Abstract
Long-term breast cancer survivors are women surviving at least 5years after diagnosis. This systematic review aimed to summarize the main characteristics and patterns of healthcare service use (frequency of visits, health providers visited, and preventive care performed) among long-term breast cancer survivors. We used standard Cochrane Collaboration methods and searched the MEDLINE and EMBASE databases up to January 2018. We included English language observational studies reporting health service use among long-term cancer survivors. The quality of the studies was appraised through the ROBINS-I assessment tool. Two independent reviewers performed both the study quality assessment and the data extraction. A total of 23 observational studies were included that reported data on health services use by long-term breast cancer survivors. Despite heterogeneity among studies, about half of them reported that breast cancer survivors visited a medical provider at least once a year, as recommended by breast cancer survival guidelines. Although survivors visited medical providers with the recommended frequency, a substantial number used specialist care instead of primary care during follow-up. The results showed underuse of the recommended annual mammogram. Long-term breast cancer survivors differ in their health services use with regard to the frequency of visits as well as the health providers seen. Our results indicate the need for active surveillance through primary care providers in coordination with specialized care. This review could help to standardize the management of breast cancer survivors and decision-makers to adapt their guidelines and clinical protocols.
Highlights
Long-term breast cancer survivors are those women who survive free from cancer recurrence or new primary cancer for at least 5 years [1]
Recent data from the NORDCAN Project show that around 87% of women diagnosed with breast cancer in the Nordic countries will live disease-free for at least 5 years and 74–83% for at least 10 years [2], which is slightly higher than in the rest of Europe
The search strategy included a combination of controlled vocabulary and search terms related to long-term breast cancer survivors and health services use, such as breast cancer, cancer survivor, survivorship, health services use, health care utilization, general practitioner, specialist, and follow-up care
Summary
Long-term breast cancer survivors are those women who survive free from cancer recurrence or new primary cancer for at least 5 years [1]. It is well-known that survival has increased in women with breast cancer, in European countries as well as in the USA, and trends suggest that it will keep increasing. In the USA, the 5-year relative survival rate for all types of breast cancer was 90% in 2014 [3]. In 2011, the survival rate for breast cancer ranked fifth for all cancers and third when analyzing only women [4]. Due to the increase in survivorship rates and life expectancy among breast cancer survivors, the pool of long-term breast cancer survivors is likely to expand considerably in the coming decades [7,8,9,10]
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