Follow-up after endometrial cancer
CMAJ 1998;158:588
See response from: O. Agboola
This article adds to the growing number of publications assessing the value of routine follow-up in cancer care. Such work is of interest to centres such as the Toronto Sunnybrook Regional Cancer Centre (TSRCC). In 199394 the TSRCC logged 38 930 nontreatment follow-up visits and saw 4045 new patients. Compared with Ontario's 7 other regional cancer centres, the TSRCC's ratio of follow-up visits to new patient visits is low (10:1; the ratios elsewhere range from 12:1 to 23:1). In general, follow-up visits represent an expensive and time-consuming portion of clinical activity at cancer centres. Health care services face increasing demands on limited resources and are under pressure to continue to improve patient care while realizing substantial cost efficiencies. In cancer care, clinicians and managers must critically examine the traditional systems and processes involved in investigation, treatment and follow-up.
There is little evidence that follow-up of asymptomatic cancer patients influences survival or quality of life.1 This is not surprising, since for the majority of cancers there is no curative treatment for relapse or progression. Effective therapy for relapse is rare.
Some of the reasons why physicians consider follow-up useful for cancer patients include evaluation of response to treatment, early detection and treatment of recurrence, monitoring of late effects of therapy, patient rehabilitation and psychological support, family and patient risk counselling, early detection of second malignant lesions, medical education for health professionals, research and investigation of new treatment for cancer relapse. It is unclear to what extent patients share these views or what follow-up services they want and from whom they prefer to receive those services.
Patients worry about recurrence and about missing symptoms of new cancer.2 About 1 in 5 report anxiety associated with follow-up visits, especially during the first post-treatment year or if the cancer is not in complete remission. Several authors have stressed the importance of follow-up involving cancer centre and community-based physicians.35
One of the challenges facing regional cancer centres is to provide a cost-effective community cancer care network to satisfy the changing needs of patients and to meet the educational and research requirements of multidisciplinary health care providers. Differences of opinion about the roles of various caregivers in the follow-up of patients with cancer suggest that changes to current practice will have to be carefully introduced in consultation with family physicians, specialists and patients.
It seems inevitable that changes are needed in the traditional system of cancer follow-up. Objectives must be articulated and the respective roles of institutions and other caregivers clarified. Patients at the TSRCC are quite clear that what they value most about follow-up is the sense that they are being looked after within a humane, caring system and that current and future follow-up policies give them ready access to expertise if and when they need it. Any improvement in the effectiveness and efficacy of follow-up care should, at a minimum, seek to preserve and enhance those characteristics.
C.E. Danjoux, MD
B. Doan, PhD
N. Hurst, RN
P. Chart, MD
C. Tan, CCHRA(A)
D. Russell, MIR
TorontoSunnybrook Regional Cancer
Centre
North York, Ont.
References
- Brada M. Is there a need to follow-up cancer patients? Eur J Cancer 1995;31(5):655-7.
- Lampic C, Wenneberg A, Schill JE, Brodin O, Glimelius B, Sjoden PO. Anxiety and cancer-related worry of cancer patients at routine follow-up visits. Acta Oncol 1994:30(2):119-25.
- Holli K, Hakama M. Continuity of the doctor/patient relationship during routine follow-up of a breast cancer patient. Supportive Care Cancer 1993;1(5):263-5.
- Williams PT. The role of family physicians in the management of cancer patients. J Cancer Educ 1994;9:67-72.
- Lauria MM. Continuity of cancer care. Cancer 1991;67(Mar 15 Suppl):1759-66.
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