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The effectiveness of personalised surveillance and aftercare in breast cancer follow-up: a systematic review.
Maaren, M. van, Hoeve, J. van, Poorthuis, J., Korevaar, J., Drossaert, C., Siesling, S. The effectiveness of personalised surveillance and aftercare in breast cancer follow-up: a systematic review. European Journal of Cancer: 2022, 175(Suppl. 1), p. S11. Abstract of the 13th European Breast Cancer Conference (EBCC), Barcelona, Spain, 16-18 November 2022
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Background
Currently, breast cancer follow-up significantly differs among hospitals, varying from one-size-fits-all to more personalised approaches. Before starting a prospective study on the effect of personalised breast cancer follow-up in the Netherlands on cancer worry and cost-effectiveness, we performed a systematic review to get insight in existing evidence on its effectiveness.
Methods
Scopus (including Medline and keywords of Embase) and Cochrane (reviews) were searched for relevant publications between 1 January 2010 and 8 April 2021. The inclusion population consisted of non-metastatic breast cancer patients ≥18 years after completing curative treatment. The search included all synonyms of ‘breast cancer’, ‘personalised’, ‘follow-up’ and ‘survivor’. We only included individualised interventions designed for use in the entire period after treatment (except endocrine therapy). Studies investigating short-term dietary, physical interventions or cognitive therapy were therefore excluded. We also excluded studies on diagnostic accuracy or feasibility, patient experiences and studies without a control group. Two reviewers independently screened all publications on title and abstract. In case of doubt, the publication was included. One reviewer extensively reviewed the included publications while consulting the second reviewer in case of doubt.
Results
In total, 2343 publications were obtained from Scopus, and 26 reviews from Cochrane. We included 36 publications for full text analysis. Six studies (al randomised trials) were deemed useful for review. Using the Cochrane risk-of-bias tool, four studies were judged low risk, one high risk and one with concerns. All studies varied in populations, intervention and outcomes. Two studies found improved QoL after patient navigation or individualised follow-up, while one study found no significant differences in both QoL and patient satisfaction. The latter showed a lower number of consultations in the intervention group. One study found that survivorship care plans led to improved survivor knowledge, while another showed that these plans did not lead to changes in number of redundant examinations. One study showed that integration of online questionnaires with remote review facilitated symptom reporting. None of the studies analysed cancer worry or cost-effectiveness. Moreover, none evaluated numbers of recurrences when the number of visits changed and none included information on the organisation of follow-up.
Conclusions
Many studies underlined the need for personalised follow-up, but its effect on cancer worry, follow-up visits, recurrences and cost-effectiveness is still unclear. A prospective study with at least three year follow-up, including both patient-reported and qualitative outcomes, which provides attention to the organisation of follow-up, will provide better insights in its effectiveness.
Currently, breast cancer follow-up significantly differs among hospitals, varying from one-size-fits-all to more personalised approaches. Before starting a prospective study on the effect of personalised breast cancer follow-up in the Netherlands on cancer worry and cost-effectiveness, we performed a systematic review to get insight in existing evidence on its effectiveness.
Methods
Scopus (including Medline and keywords of Embase) and Cochrane (reviews) were searched for relevant publications between 1 January 2010 and 8 April 2021. The inclusion population consisted of non-metastatic breast cancer patients ≥18 years after completing curative treatment. The search included all synonyms of ‘breast cancer’, ‘personalised’, ‘follow-up’ and ‘survivor’. We only included individualised interventions designed for use in the entire period after treatment (except endocrine therapy). Studies investigating short-term dietary, physical interventions or cognitive therapy were therefore excluded. We also excluded studies on diagnostic accuracy or feasibility, patient experiences and studies without a control group. Two reviewers independently screened all publications on title and abstract. In case of doubt, the publication was included. One reviewer extensively reviewed the included publications while consulting the second reviewer in case of doubt.
Results
In total, 2343 publications were obtained from Scopus, and 26 reviews from Cochrane. We included 36 publications for full text analysis. Six studies (al randomised trials) were deemed useful for review. Using the Cochrane risk-of-bias tool, four studies were judged low risk, one high risk and one with concerns. All studies varied in populations, intervention and outcomes. Two studies found improved QoL after patient navigation or individualised follow-up, while one study found no significant differences in both QoL and patient satisfaction. The latter showed a lower number of consultations in the intervention group. One study found that survivorship care plans led to improved survivor knowledge, while another showed that these plans did not lead to changes in number of redundant examinations. One study showed that integration of online questionnaires with remote review facilitated symptom reporting. None of the studies analysed cancer worry or cost-effectiveness. Moreover, none evaluated numbers of recurrences when the number of visits changed and none included information on the organisation of follow-up.
Conclusions
Many studies underlined the need for personalised follow-up, but its effect on cancer worry, follow-up visits, recurrences and cost-effectiveness is still unclear. A prospective study with at least three year follow-up, including both patient-reported and qualitative outcomes, which provides attention to the organisation of follow-up, will provide better insights in its effectiveness.