Sharing long term follow-up of breast cancer survivors with family physician: a province of Lecco experience

Abstract

Background: Breast cancer (BC) is commonly diagnosed at early stage and more than 80% of patients (pts) are long-term survivors. Most cancer society guidelines recommend a non-intensive follow-up, that, after 5 years from diagnosis, consists of annual medical history, physical examination and surveillance mammogram. The role of family physician in the management of BC follow-up is still under discussion. Material and methods: Since 2013, we have launched a shared BC survivor follow up program involving family physicians working in the Province of Lecco. Pts with diagnosis of early BC have been referred to their family physician to continue surveillance with annual physical examination and mammogramat the completion of adjuvant treatment and after at least 5 years of follow-up, if no clinical evidence of disease recurrence was present. In case of suspicious disease recurrence, a direct access to our oncology unit has been offered. Results: From May 2013 to March 2017, 643 women have been enrolled in our program. All pts were disease free (as per clinical assessment), had completed adjuvant treatment and at least 5 years of follow-up at the time of enrollment. 11% of pts had ductal carcinoma in situ, 66% invasive ductal carcinoma, 7% invasive lobular carcinoma and 16% other histologic subtypes. 11% was hormonal receptor negative and 7% was HER2 positive. 44% was G2 and 34% G3. 25% received chemotherapy followed by hormonal treatment, 9% received adjuvant chemotherapy alone and 61% received hormonal treatment alone. Median follow up time was 8 years (range 5-23 years). 10/643 (1,6%) pts experienced BC recurrence: 3 had distant metastasis, 4 unilateral breast recurrence and 3 contralateral. Those with local recurrence underwent breast surgery followed by adjuvant chemotherapy in 1 case, chemotherapy and hormonal treatment in 1 and hormonal treatment alone in 5. Pts with distant metastasis are still alive and currently on treatment (1 with chemotherapy, 2 with hormonal treatment). Conclusion: This preliminary analysis has shown the feasibility of our program with a significant number of pts referred to their family physicians, reducing the need for specialist follow-up. Only a small proportion of pts experienced subsequent relapse requiring reassessment by the treating oncologist. Further analysis is planned to define the adherence to the shared follow-up.