Evaluating the De-Escalation of Surveillance for Patients Who Have Undergone Curative Treatment for Breast Cancer

Royal College of Surgeons, Ireland560 enrolled

Overview

Patients who were diagnosed with breast cancer and have finished their treatment will be given the opportunity to be part of this study. These patients will have been attending surveillance at the Breast Centre in Beaumont Hospital, Ireland for 2 years prior. These patients, who are doing well after breast cancer treatment, will be given the opportunity to enrol in this study, potentially being discharged from in person surveillance after 2 years, while still attending for their annual mammogram. Investigators intend to find out if a simpler follow-up plan could work just as safely, while also improving the patients quality of life.

Breast cancer is the most common cancer in women around the world. That means a lot of women are affected by it every year, and it's important that investigators always look for ways to improve their care, not just during treatment, but afterwards too. After treatment for early-stage breast cancer, patients usually come back to the hospital for regular check-ups for up to five years. These visits are based on old guidelines, and even though breast cancer treatment has improved a lot over the years, the follow-up schedule has stayed the same. This study is being done to see if investigators can safely reduce the number of hospital visits after treatment, while still keeping patients healthy and well looked after. Right now, in Ireland, patients are asked to attend follow-up appointments at 6, 12, 18, 24, 36, 48 and 60 months (that's every 6 to 12 months for five years). These clinic visits often involve long waits and can cause stress or anxiety. At the same time, patients are also invited for a mammogram once a year. Recent research shows that most recurrences of breast cancer are found by patients themselves or during their annual mammograms, not necessarily at these clinic visits. That is why investigators are looking at whether the number of hospital appointments can safely be reduced , without affecting patient safety. In this study, some patients will continue with the usual five-year clinic schedule. Others will only attend hospital clinics for the first two years (at 6, 12, 18 and 24 months), and after that, they will no longer need to come in for the extra follow-up visits - but they will still have their annual mammograms as normal. Investigators will also ask all participants to complete a short questionnaire once a year. This will help investigators understand how the different follow-up plans affect quality of life, and how patients feel about their care. This research study is taking place to find out if fewer hospital check-ups, combined with continued mammogram screening, is just as safe and possibly better for patients' wellbeing.

Study Type

Interventions

Deescalation of surveillanceOTHER

Patients will attend hospital-based in-person specialist surveillance clinics according to the current practice post initial diagnosis for the first two years following curative resection and treatment of their primary breast cancer and then discharged from the service (i.e.: patients will receive six monthly specialist follow-up appointments for the first 24 months). Mammographic surveillance will be as described for the control group. Every patient will undergo an annual mammogram until the age of seventy years (or if aged 70 at the time of diagnosis, they will have an annual mammogram for five years in total). As per standard practice all results from these annual mammogram studies will be copied to the patients' general practitioner. If any abnormalities are detected on mammogram the patient will be contacted. All participants will complete the health-related quality of life questionnaire, EQ5D5L at the 24 (2 year), 36 (3 year), 48 (4 year) and 50 month (5 year) timepoint.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Female participants aged 18 years or older * Prior diagnosis of primary breast cancer treated with curative intent * Currently under cancer surveillance and at the 24-month follow-up timepoint * No clinical or radiological evidence of disease recurrence or metastasis at the time of recruitment (e.g., no palpable mass, skin or nipple changes, or suspicious findings on imaging) * Able to read, write, and speak English sufficiently to complete the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire (paper-based or via telephone) * Resident in the Republic of Ireland with a fixed address and intention to continue follow-up within the Irish healthcare system Exclusion Criteria: * Evidence of breast cancer recurrence or metastatic disease at the time of recruitment * Inability to provide informed consent * Inability to complete study questionnaires (e.g., due to language barriers or cognitive impairment) * Not resident in the Republic of Ireland or not intending to remain in follow-up within the Irish healthcare system

Outcomes

Primary Outcomes

Health Related Quality of Life

Health related quality of life will be assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L). The EQ-5D-5L includes five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with five levels of severity. Responses are converted into a single index value, typically ranging from less than 0 (worse than death) to 1 (full health), where higher scores indicate better health-related quality of life. The instrument also includes a visual analogue scale (EQ VAS) ranging from 0 to 100, with higher scores indicating better perceived health.

Time frame: Participants will complete the questionnaire (paper-based or via telephone with the Advanced Nurse Practitioner) at 2, 3, 4, and 5 years.

Secondary Outcomes

Recurrence Rate and Time to Recurrence

Recurrence rate will be defined as the proportion of participants diagnosed with disease recurrence during follow-up. Time to recurrence will be defined as the time from study enrollment to the date of first confirmed recurrence.

Time frame: Assessed at 2, 3, 4, and 5 years post enrollment, time to recurrence analyzed up to 5 years.

Change in Number of Patients Attending via Symptomatic Referral Pathway

The number of participants attending through the symptomatic referral pathway will be recorded and compared before and after implementation of the intervention.

Time frame: Annually at 1, 2, 3, 4, and 5 years.

Economic Burden of Surveillance Pathway

A cost analysis will be conducted comparing the standard surveillance pathway with the de-escalated surveillance pathway, including healthcare utilization costs.

Time frame: Costs will be assessed annually over 5 years and analyzed at 5 year follow-up.

Waiting Time for Newly Diagnosed Breast Cancer Patients

Waiting time will be defined as the time from referral to first outpatient appointment for patients with newly diagnosed breast cancer. Annual changes in waiting times will be evaluated.

Time frame: Assessed annually at 1, 2, 3, 4, and 5 years.