Follow-up after endometrial cancer Can Med Assoc J 1998;158:588-90 See response from: O. Agboola Evidence-based medicine, the medical profession's new mantra, has the noble aim of taking precious medical resources away from procedures with no proven benefit. The study by Agboola and colleagues is therefore of great interest. I suspect that future studies will show that, for most malignant lesions, routine tests for detecting occult metastatic disease fail to improve survival or reduce morbidity. Eliminating such tests would clearly be desirable. The next foreseeable step would be to transfer routine follow-up care from the expensive oncologist to either a family doctor or a trained nurse specialist. Studies to evaluate the feasibility and efficacy of such a practice are already under way. The most obvious objection to this concept is that patients' quality of care might be affected in ways that cannot necessarily be measured by conventional outcomes, including "quality of life." But there are several important, though less obvious, reasons to maintain specialist follow-up. Many patients with potentially curable cancer present with unusual case scenarios for which evidence-based medicine will never provide management guidelines. The specialist must then rely on his or her slowly acquired professional experience and judgement. Without the opportunity to provide long-term follow-up for many patients and to manage chronic treatment-related complications, such experience and judgement will never be acquired. When patients do experience a relapse, the oncologist must choose from a variety of equivalent management options. The most appropriate choice for that patient can only be made if one understands the patient's premorbid personality, lifestyle and social support structure (or lack thereof). Such knowledge cannot be acquired during a single consultation at the time of relapse. Finally, I would like to argue that those of us who must spend most of our day breaking devastating news or attempting to palliate progressive disease symptoms need well follow-up patients, our successes, to give us the emotional strength to do the more difficult part of our work. Ellen Warner, MD, MSc Division of Medical Oncology Toronto­Sunnybrook Regional Cancer Centre North York, Ont. Send a letter to the editor responding to this article Envoyez une lettre à la rédaction au sujet de cet article | CMAJ March 10, 1998 (vol 158, no 5) / JAMC le 10 mars 1998 (vol 158, no 5) |