Intensive follow-up for women with breast cancer: review of clinical, economic and patient’s preference domains through evidence to decision framework View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-10-19

AUTHORS

Alessandra Lafranconi, Liisa Pylkkänen, Silvia Deandrea, Anke Bramesfeld, Donata Lerda, Luciana Neamțiu, Zuleika Saz-Parkinson, Margarita Posso, David Rigau, Ivan Sola, Pablo Alonso-Coello, Maria José Martinez-Zapata

ABSTRACT

BACKGROUND: Women treated for breast cancer are followed-up for monitoring of treatment effectiveness and for detecting recurrences at an early stage. The type of follow-up received may affect women's reassurance and impact on their quality of life. Anxiety and depression among women with breast cancer has been described, but little is known about how the intensity of the follow-up can affect women's psychological status. This study was undertaken to evaluate the effects of intensive vs. less-intensive follow-up on different health outcomes, to determine what are women's preferences and values regarding the follow-up received, and also assess the costs of these different types of follow-up. METHODS: A systematic review following standard Cochrane Collaboration methods was carried out to assess the efficacy of intensive follow-up versus non-intensive follow-up in breast cancer patients. Two additional reviews on women's preferences and economic evidence were also carried out. The search was performed up to January 2016 in: MEDLINE, EMBASE, PDQ, McMaster Health Systems Evidence, CENTRAL, and NHS EED (through The Cochrane Library). The quality of evidence was assessed by GRADE (for quantitative studies) and CerQUAL (for qualitative studies). Several outcomes including mortality, breast cancer recurrences, quality of life, and patient satisfaction were evaluated. RESULTS: Six randomised trials (corresponding to 3534 women) were included for the evaluation of health outcomes; three studies were included for women's values and preferences and four for an economic assessment. There is moderate certainty of evidence showing that intensive follow-up, including more frequent diagnostic tests or visits, does not have effects on 5- or 10-year overall mortality and recurrences in women with breast cancer, compared with less intensive follow-up. Regarding women's preferences and values, there was important variability among studies and within studies (low confidence due to risk of bias and inconsistency). Furthermore, intensive follow-up, as opposed to less intensive follow-up, is not likely to be cost-effective. CONCLUSIONS: Less intensive follow-up appears to be justified and can be recommended over intensive follow-up. Resources could thus be mobilised to other aspects of breast cancer care, or other areas of healthcare. More... »

PAGES

206

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12955-017-0779-5

DOI

http://dx.doi.org/10.1186/s12955-017-0779-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1092304068

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29052503


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29 schema:description BACKGROUND: Women treated for breast cancer are followed-up for monitoring of treatment effectiveness and for detecting recurrences at an early stage. The type of follow-up received may affect women's reassurance and impact on their quality of life. Anxiety and depression among women with breast cancer has been described, but little is known about how the intensity of the follow-up can affect women's psychological status. This study was undertaken to evaluate the effects of intensive vs. less-intensive follow-up on different health outcomes, to determine what are women's preferences and values regarding the follow-up received, and also assess the costs of these different types of follow-up. METHODS: A systematic review following standard Cochrane Collaboration methods was carried out to assess the efficacy of intensive follow-up versus non-intensive follow-up in breast cancer patients. Two additional reviews on women's preferences and economic evidence were also carried out. The search was performed up to January 2016 in: MEDLINE, EMBASE, PDQ, McMaster Health Systems Evidence, CENTRAL, and NHS EED (through The Cochrane Library). The quality of evidence was assessed by GRADE (for quantitative studies) and CerQUAL (for qualitative studies). Several outcomes including mortality, breast cancer recurrences, quality of life, and patient satisfaction were evaluated. RESULTS: Six randomised trials (corresponding to 3534 women) were included for the evaluation of health outcomes; three studies were included for women's values and preferences and four for an economic assessment. There is moderate certainty of evidence showing that intensive follow-up, including more frequent diagnostic tests or visits, does not have effects on 5- or 10-year overall mortality and recurrences in women with breast cancer, compared with less intensive follow-up. Regarding women's preferences and values, there was important variability among studies and within studies (low confidence due to risk of bias and inconsistency). Furthermore, intensive follow-up, as opposed to less intensive follow-up, is not likely to be cost-effective. CONCLUSIONS: Less intensive follow-up appears to be justified and can be recommended over intensive follow-up. Resources could thus be mobilised to other aspects of breast cancer care, or other areas of healthcare.
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42 MEDLINE
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44 NHS EED
45 PDQ
46 additional review
47 anxiety
48 area
49 areas of healthcare
50 aspects
51 assessment
52 breast cancer
53 breast cancer care
54 breast cancer patients
55 breast cancer recurrence
56 cancer
57 cancer care
58 cancer patients
59 cancer recurrence
60 care
61 certainty
62 collaboration method
63 cost
64 decision framework
65 depression
66 diagnostic tests
67 different health outcomes
68 different types
69 domain
70 early stages
71 economic assessment
72 economic evidence
73 effect
74 effectiveness
75 efficacy
76 evaluation
77 evidence
78 framework
79 frequent diagnostic tests
80 grade
81 health outcomes
82 healthcare
83 impact
84 important variability
85 intensity
86 life
87 method
88 moderate certainty
89 monitoring
90 mortality
91 outcomes
92 overall mortality
93 patient satisfaction
94 patients
95 preference domain
96 preferences
97 psychological status
98 quality
99 quality of evidence
100 quality of life
101 reassurance
102 recurrence
103 resources
104 review
105 satisfaction
106 search
107 stage
108 standard Cochrane Collaboration methods
109 status
110 study
111 systematic review
112 systems evidence
113 test
114 treatment effectiveness
115 trials
116 types
117 values
118 variability
119 visits
120 women
121 women's preferences
122 women's psychological status
123 women's reassurance
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