Background and Context:
Policy makers internationally are seeking alternatives to follow-up care in an acute setting. In Ireland follow-up by oncologists has been the traditional approach. As breast cancer incidence grows and
The NCCP set out to develop and implement an evidence-based policy recommendation as to long-term clinical follow-up of women with early breast cancer in Ireland.
The policy development was overseen by a steering committee with representation from medical oncology, nursing, public health, general practice and patients. The approach was to
· Critically examine evidence in the medical literature
· Assess current utilisation of breast clinics for long-term follow up
· Undertake focus group research with patients.
Evidence shows that long term hospital-based follow-up of women with non-metastatic breast cancer does not improve survival or quality of life when compared with follow-up in primary care1. In Ireland, 12% of women attending routine follow-up appointments were at least ten years post diagnosis. Discharge to primary care at five years could release 5% of total breast clinic appointments. Women highlighted issues such as attachment to specialist services, importance of communication and need for clarity as to where responsibility of care lies.
The agreed policy is that women with early breast cancer are discharged from hospital follow-up after five years, provided active treatment is complete. Critically, hospitals retain responsibility for coordinating annual follow-up mammography.
Outcomes/What was learned:
Implementation of the policy has been supported by clearly outlining and communicating roles and responsibilities. Concerns in primary care related to general practitioner workloads rather than challenges to the appropriateness of the policy. A strategic approach to survivorship is required to meet the needs of the growing numbers of cancer survivors in Ireland and around the world.