There is limited evidence supporting the benefit of surveillance and no consensus on the optimal follow-up of patients after a breast cancer diagnosis. We aim to evaluate the frequency and duration of follow-up, focusing on the management of endocrine therapy and the how relapses were detected.
We performed a retrospective chart review on 100 patients and collected data on disease stage, disease subtype, follow-up frequency, relapse rates, and endocrine therapy tolerance.
The median number of specialist visits were 24, and the median follow-up duration 60 months. 93% (76/82) of patients on adjuvant endocrine treatment were assessed for treatment tolerability within 12 weeks of commencing treatment. Over the course of treatment 55% required treatment modifications; 11% permanent cessation, 11% switched to another drug within same class and 32% switched to a different drug class. Early tolerability of endocrine therapy did not predict long-term tolerance as 35% of patients of patients tolerating treatment at 12 weeks required subsequent treatment modification. 11 patients relapsed (2 new primary, 1 loco-regional, 8 distant metastases) and these recurrences were mostly diagnosed by patients developing new symptoms (7/11), while 4 out of 11 recurrences were detected at routine specialist follow-up visits (2 new primary, 1 loco-regional and 1 metastatic). The majority of relapses (9/11) occurred in patients with stage 2/3 disease.
Early tolerance of endocrine treatment does not predict long-term toxicity and is an ongoing issue that requires monitoring and should be the primary focus of breast cancer follow-up, in conjunction with lifestyle interventions. In our study, routine clinical surveillance did not detect a significant number of relapses. Follow-up intervals could be rationalised and shared with primary care providers with the proviso of concurrent mechanisms for rapid re-entry into the service should patients develop symptoms or concerns.