Views of primary care physicians and oncologists on cancer follow-up initiatives in primary care: an online survey.

INTRODUCTION: Primary care physicians (PCPs) are playing an increasing role in the follow-up of cancer in England. In 2003 a Cancer Care Review (CCR) was introduced to ensure contact between PCPs and cancer patients within 6 months of diagnosis. The NHS also intends to introduce survivorship care plans (SCP). The aims of this study were to: describe current practice and views in primary care with respect to the CCR and information provision from secondary to primary care following final discharge from hospital follow-up; and to seek views on the perceived usefulness, content, and feasibility of a SCP. METHODS: An on-line questionnaire survey of 100 oncologists and 200 PCPs. RESULTS: Half of PCPs undertook the CCR opportunistically, and only 64% had an agreed structure. Forty percent felt the CCR was useful for the doctor, and 60% useful for the patient. Most PCPs and oncologists think a SCP would be useful, but only 40% oncologists thought that it would be easy to produce. At discharge from follow-up, more than half of oncologists said they provided information on histology, treatment, requirements for screening and surveillance, and referral guidance. Less than half provide information on potential late effects and symptoms of recurrence. PCPs felt that information on all of these areas was important and that the information they receive is often inadequate. DISCUSSION/CONCLUSIONS: The CCR has not been implemented systematically. There is support for the introduction of a SCP and broad agreement on content. However, careful planning is needed to ensure all necessary information is included and to overcome barriers of implementation. IMPLICATIONS FOR CANCER SURVIVORS: Further research should explore what cancer survivors would find useful in a primary care-based CCR and what should be included in a SCP. This should be clearly communicated to the relevant health care professionals to maximise the benefits cancer survivors and their families gain from these policy initiatives.

Long-term population-based risks of breast cancer after childhood cancer.

Previous studies have reported substantially increased risks of breast cancer among survivors of childhood cancer at 10-20 years posttreatment. Whether these excess risks are sustained beyond 40 years of age when general population incidence of breast cancer begins its steep increase is largely unknown. We quantified the risk of breast cancer in adult female survivors with considerably more survivors followed-up beyond 40 years of age than previously available. Standardized Incidence Ratios (SIR), Excess Absolute Risks (EAR), and cumulative incidence were calculated within a population-based cohort of 8,093 female survivors of childhood cancer. Poisson regression models were used to model SIRs and EARs in a multivariable setting. Eighty-one survivors developed a primary breast cancer, where 37.5 were expected (SIR= 2.2, 95% CI: 1.7-2.7). SIRs decreased significantly with increasing attained age (p(trend) < 0.001) to an SIR of 0.9 (95% CI: 0.5-1.8) at ages beyond 50 years; EARs increased significantly to about 40 years of age (p(trend) < 0.001) but then plateau. Between 30 and 49 years of age survivors experienced approximately 1 extra breast cancer per 1,000 survivors per year. Overall, 3% developed breast cancer by the age of 50. The substantially increased relative risks of breast cancer observed at 10-20 years postdiagnosis are not sustained into ages at which the risk of breast cancer in the general population becomes substantial. Among women who survived to an age of at least 50 years there is currently no evidence of an increased risk of breast cancer.