Introduction
Guidelines recommend long term follow-up for women after breast cancer treatment.[1] As breast cancer incidence increases and survival rates improve, progressively more women will require follow-up care. New models of care are required to address the increasing demand on the specialist workforce.
Aim
This program aimed to evaluate the extent to which shared follow-up care for early breast cancer (EBC) supports best practice and identify the comparative cost of shared follow-up care for EBC in a general practice setting compared to a specialist-led setting.
Method
Following a demonstration of shared follow-up care for EBC (2009-2011), an evaluation to assess the extent to which the model supports the delivery of best practice follow-up care was conducted (2013-15). Follow-up appointments involving 580 patients across five sites were documented over a two year period and analysed. An economic evaluation and financial impact model were used to estimate the national costs of EBC follow-up care in the general practice and specialist-led settings using an epidemiological approach.
Results
The majority of shared care follow-up visits included completion of key examinations and actions in accordance with guideline recommendations. Mammograms were provided to 73% of patients at least annually, in accordance with guidelines. Compared to specialists, a significantly higher proportion of general practitioners reviewed psychosocial issues, family history, menopausal status, and other health conditions, and discussed secondary prevention behaviours. The examination of potential cost savings showed that over a lifetime (20, 25 or 30 years) of follow-up care, a shared care model is more cost-efficient than the specialist-led model, and also frees up specialist hours.
Conclusion
Cancer Australia’s evaluations demonstrated that shared follow-up care for EBC is delivered in accordance with guidelines. There are also cost and time savings translatable to additional and earlier patient care that can be achieved if shared follow-up care is implemented.
[1] National Breast and Ovarian Cancer Centre. Recommendations for follow-up of women with early breast cancer. Surry Hills. NBOCC, 2010.