Introduction
Methods
Study design and search strategy
Inclusion and exclusion criteria
Quality assessment and data extraction
Analysis and synthesis of the results
Results
Population characteristics
Study ID, country | Objective (abstract) | Design | Population | ||||
---|---|---|---|---|---|---|---|
Target population | Age | Years of diagnosis | Comorbidities during follow-up | Survivorship | |||
Baena-Cañada 2013, Spain [28] | Describe the follow-up received (primary or specialist/hospital care) by long-term BC survivors | Retrospective cohort study | N = 98 BC disease-free patients mainly visited in: 1) primary care n = 60, 2) specialist care n = 38 | 1. Primary care mean age 65.73 years 2. Specialist care mean age 58.55 years | From 2003 to 2007 | Clinical events diagnosed during follow-up | At least 5 years (median follow-up 128 months |
Coughlan 2016, Ireland [29] | Describe healthcare utilization in cancer survivors aged 50 years or more | Retrospective cohort study | N = 142 with diagnosis of BC | ≥ 50 years (mean age 65.5 years) | 2003 or before | Number of comorbid conditions | 2–5, 6–10, 11+ years |
Doubeni 2006, USA [30] | Examine patterns and factors associated with the use of surveillance mammography among BC survivors | Retrospective cohort study | N = 797 BC survivors diagnosed with incident primary BC | ≤ 55 years old (mean age 69.7 years) | 1996 and 1997 | Charlson index | Mean follow-up 3.84 years |
Duffy 2006, USA [31] | Examine health screening practices in BC survivors | Retrospective cohort study | N = 85 BC survivors + N = 340 age-race matched controls with no BC history | 40 and older (mean age in cases: 61.7 years) | From 1996 to 1998 | NS | At least 5 years |
Ferro 2014, Spain [32] | Characterize healthcare services use and health status in long-term survivors of breast, prostate, and colorectal cancer | Retrospective multicentric cohort study | N = 344 disease-free patients diagnosed with BC | 40–≤ 80 years | From 1999 to 2004 | Permanent stoma, sexual impotence, urinary incontinence, lymphedema, loss of mobility in upper limbs, early menopause, infertility, others | 5 to 10 years since diagnosis |
Freedman 2017, USA [33] | Routine surveillance mammography in the past year by 5- and 10-year life expectancy | Retrospective cohort study | N = 1040 women with a history of BC and with information about their last mammogram | 65 years or more | Before 2000 | Obesity, emphysema, diabetes, difficulty in walking, instrumental activities of daily living | 5 to 10 years’ since diagnosis |
Giuliani 2016, Italy [34] | Evaluate adherence to surveillance mammography and/or clinical breast examination | Retrospective cohort study | N = 1304 in situ and invasive BC with surgical treatment | No age restriction | From 1990 to 2000 | Elixhauser comorbidity index | 6 months to 10 years |
Grunfeld 2010, Canada [35] | Describe patterns of follow-up care in BC survivors | Retrospective cohort study | N = 11,219 diagnosed with BC | No age restriction (mean age 60.1 years) | 1998 and 1999 | Charlson index | 1 to 5 years after diagnosis (mean follow-up 52.9 months) |
Khan 2010, UK [36] | Use of cancer and non-cancer-related preventive health practices in cancer survivors | Retrospective cohort study | N = 145,662 breast, colorectal and prostate cancer survivors + age and gender matched controls with no history of cancer (N = 18,612) | 30 or more years (mean age 67.65 years) | At least 1998 to 2001 | Charlson index | At least 5 years |
Khan 2011, UK [37] | Describe the consultation patterns of adult survivors of breast, colorectal, and prostate cancer in primary care at different points of survival | Retrospective cohort study | N = 18,612 BC survivors, N = 116,418 controls | Median age 72 years | Before 1998 to 2001 | Comorbidities in general | At least 5 years |
Lafata 2015, USA [38] | Evaluate annual use of preventive care screenings in breast and prostate cancer survivors | Retrospective cohort study | N = 3743 BC survivors + N = 31,927 controls with no BC history | Older than 50 years (mean age 66.5 years) | From 2000 to 2008 | NS | 1 to 5 years after diagnosis |
Lu 2011, The Netherlands [39] | Assess the use of long-term routine hospital follow-up care and to describe the reasons for stopping this follow-up care | Retrospective cohort study | N = 662 patients diagnosed with BC + age and follow-up duration matched controls | Median age 57.7 years | From 1989 to 2003 | Comorbidity (yes/no) | 0.3 to 18.1 years (median follow-up 9 years) |
Maddams 2011, UK [40] | Describe inpatient and day care hospital activity among cancer survivors | Retrospective cohort study | Cancer survivors alive for at least some portion of 2006 (person-time analysis) | No age restriction | From 1990 to 2006 | NS | < 1 to 16 years |
Nord 2005, Norway [41] | Study health services use and health status in cancer survivors compared with controls without cancer | Retrospective cohort study | N = 258 BC survivors + 774 age and gender matched controls with no cancer history | Mean age 69 years | From 1995 to 1997 | Back pain, arthralgia, shortness of breath, palpitation, nausea, dyspepsia, diarrhea | At least 5 years |
Pollack 2009, USA [42] | Characterize providers who provide care to cancer survivors of 5 years or more | Retrospective cohort study | N = 26,972 BC survivors | ≤ 60 years (mean age 71.7 years) | Between 1992 and 1997 | Charlson index | At least 5 years |
Risendal 2015,USA [43] | Evaluate adherence to ASCO recommendations for surveillance testing in long-term BC survivors | Retrospective cohort study | N = 298 BC survivors | Mean age at diagnosis: 54 years | From 1999 to 2004 | NS | 6 years after diagnosis (average follow-up 6.7 years) |
Urquhart 2017, Canada [44] | Investigate patterns of follow-up care in cancer survivors | Retrospective cohort study | N = 5167 BC survivors alive at least 1 year after diagnosis | No age restriction | From 2006 to 2013 | NS | At least 1 to 9 years |
Wirtz 2014, USA [45] | Evaluate factors related to long-term surveillance mammography in BC survivors | Retrospective cohort study | N = 3965 women diagnosed with histologically confirmed incident stage I or II BC and alive or recurrence-free for 120 days after completing surgery for the incident BC | ≥ 18 years (mean age at diagnosis: 62.6 years) | From 1990 to 2008 | Obesity, lymph node status, Charlson comorbidity index score, | 1 to 10 years (median follow-up years: 6) |
Hsieh 2018, China [46] | Measure the prevalence of vertebral fractures in BC survivors | Cross-sectional study | N = 200 BC survivors aged 50–70 years who initiated BC treatment at least 5 years prior to enrolment + 200 matched controls | No age restriction (mean age 57.5 years) | 2008 | Osteoporosis, BMI, years since menopause | At least 5 years |
Peuckmann 2008, Denmark [47] | Investigate long-term BC survivors healthcare utilization, health, and employment | Cross-sectional study | N = 1316 patients diagnosed with BC who survived for 5–15 years without recurrence or a second cancer | No age restriction (mean age 66.5 years) | From 1989 to 1999 | Obesity, presence of sequelae | 5 to 15 years |
Van de Poll-Franse 2006, The Netherlands [48] | Compare self-reported healthcare utilization between 10-year BC survivors and the general population | Cross-sectional study | N = 254 women diagnosed with BC | No age restriction (35–75 years) | 1993 | In general, painful arm, fatigue | 10 years |
Weaver 2014, USA [49] | Describe follow-up care in cancer survivors | Cross-sectional study | N = 374 BC survivors | 29–≤ 80 years | From 1991 to 2002 | NS | 4 to 14 years (stratified in two categories: 4–9 and 10–14 years) |
Wiseman 2015, USA [50] | Describe the association between time of diagnosis and type of clinician providing care | Cross-sectional study | N = 1024 with a self-reported history of BC no longer receiving treatment for cancer (> 5 years n = 737) | 18 years old or more (mean age 69.4 years) | 2004 or before | BMI, diabetes, cardiovascular disease | 0 to > 6 years after diagnosis (72% > 6 years from diagnosis) |
Outcomes
Study ID, country | Health services use | Preventive care | ||
---|---|---|---|---|
Frequency of use | Description of health providers visited | Mammography use | Preventive activities | |
Baena-Cañada 2013, Spain [28] | No. of visits per patient per year: 0.98 visits in primary care (SD 0.48) and 1.11 in specialist care (SD 0.38). Scheduled visits accounted for 44.6% of visits to primary care and 94.6% of those to specialist care (p = 0.19). | NS | The mean number of visits per patient and year due to mammograms was 0.80 (0.40) in primary care and 0.92 (0.27) in specialist care. | NS |
Coughlan 2016, Ireland [29] | The probability of an outpatient specialist office visit was 11.8% higher in patients surviving 6–10 years and 14% higher for those surviving 11 years or more after their cancer diagnosis than in respondents with no history of cancer. The average marginal effect of having a primary care physician visit at 5–10 years after diagnosis was 0.049(p > 0.05) while that of having an outpatient visit was 0.118 (p < 0.01). A decrease was found after the 11th year as the average marginal effect of having a primary care physician visit was 0.030(p > 0.05) and that of an outpatient visit was 0.140 (p < 0.001). | NS | NS | NS |
Doubeni 2006, USA [30] | BC survivors were 3.49 (2.55–4.79) times more likely to visit a gynecologist and 2.21 (1.73–2.82) times more likely to visit a family physician/internist than other types of health professional. | NS | In the 5th year, only 63% had mammograms. Women aged 75 years or older with higher levels of comorbidity were significantly less likely to have mammograms (OR = 0.35, 95% CI 0.23–0.52). The strongest predictor was outpatient visits to a gynecologist (OR = 3.49, 95% CI 2.55–4.79) or a primary care physician (OR = 2.21, 95% CI 1.73–2.82). | NS |
Duffy 2006, USA [31] | NS | NS | Most BC survivors reported appropriate mammography screening (OR = 2.76, 95% CI 1.51–5.05) | There were no significant differences among the odds for flu shot (OR = 1.43, 95% CI 0.76–2.67), PAP (OR = 0.98, 95% CI 0.60–1.62) or general physician exam (OR = 1.07, 95% CI 0.46–1.34). |
Ferro 2014, Spain [32] | No significant differences were observed (p > 0.065) between 5- and 10-year survivors. BC survivors reported follow-up visits, mainly to the oncologist and were those who reported most visits (p > 0.001); 18.9% had a visit for cancer-related morbidity and 71.5% for non-cancer-related morbidity. | A primary care physician was seen by patients needing medical care related to cancer in the last 12 months (38.5%). In visits not related to cancer morbidity, the primary care physician was also the main health professional visited (72.8%). | NS | NS |
Freedman 2017, USA [33] | Life expectancy was 5 or more years in 8.6% and 10 or more years in 35%. | 94.2% reported visiting a primary care physician in the last 12 months and 5.8% a specialist. Of those who had a mammogram, 79.1% visited their primary care physician in the last 12 months and 75% visited specialist care. | A lower life expectancy (mortality risk > 50%) remained significantly associated with lower odds of surveillance mammography in the last 12 months (OR [5 years life expectancy] = 0.4, 95% CI 0.3–0.8). Women with more than 6 visits to the health services in the last 12 months had twice the likelihood of undergoing a surveillance mammogram (OR = 2.1, 95% CI 1.3–3.4). | NS |
Giuliani O 2016, Italy [34] | NS | NS | The adjusted OR of using a yearly mammography and/or clinical breast exam in women older than 75 years old was OR = 0.16, 95% CI 0.10–0.24 and was OR = 0.45, 95% CI 0.29–0.71 while in women aged 65–74 years. | NS |
Grunfeld 2010, Canada [35] | The average number of visits diminished over time (1.9 in year 5) except in patients aged 80 years or more. | Most women saw both an oncologist and a primary care provider but this diminished over time. | The number of surveillance mammograms decreased over time: year 3 = 68%, year 4 = 69% and year 5 = 67.4% | NS |
Khan 2010, UK [36] | NS | NS | BC survivors were less likely to have a screening mammogram than controls (OR = 0.78, 95% CI 0.66–0.92) | BC survivors were more likely to have a bone density scan (OR = 1.26, 95% CI 1.10–1.44), influenza vaccination (OR = 1.15, 95% CI 1.07–1.23) and a cervical smear (OR = 1.14, 95% CI 1.03–1.25) than controls. |
Khan 2011, UK [37] | Slight increase in the overall number of consultations among BC (IRR = 1.11, 95% CI 1.09–1.12) vs controls. | BC and colorectal cancer survivors had higher rates of primary care physician consultations in the first 10 years after diagnosis. | NS | NS |
Lafata 2015, USA [38] | In the 5th year, survivors, made a mean number of 2.3 visits (SD 3.3) to an oncologist, 2 visits (SD 1.6) to a surgeon and 4.6 visits to a PCP (SD 4.9). | NS | NS | In adjusted models, BC survivors had an OR = 1.15, 95% CI 1.09–1.21 for CRC screening, OR = 3.59, 95% CI 3.26–3.96 for PAP, OR = 0.84, 95% CI 0.80–0.89 for lipid profile and OR = 1.53 95% CI 1.42–1.65 for bone densitometry. |
Lu 2011, The Netherlands [39] | Long-term hospital visits decreased over time. After the 5th year, the average number of visits was 1 per year. Women diagnosed after the age of 70 years were less likely to underuse hospital follow-up (OR 0.64, 95% CI 0.42–0.96). The opposite was found for those women who survived 6 to 10 years after primary treatment (OR 2.86, 95% CI 2.26–3.62). | NS | Underutilization in 30–40% patients during the routine hospital follow-up phase | NS |
Maddams 2011, UK [40] | The mean number of days spent in hospital for a cancer-related reason was 0.4 at 5 years since diagnosis and 0.3 at 16 years. For non-cancer-related conditions, this number was 0.5 at 5 years and 0.2 at 16 years. | NS | NS | NS |
Nord 2005, Norway [41] | NS | 74% of BC survivors saw a primary care physician in the last 12 month, 49% saw a specialist physician in a hospital, 18% saw a physical therapist/chiropractor, and 8% used complementary and alternative medicine. | NS | NS |
Pollack 2009, USA [42] | The percentage of visits to primary care did not decrease annually. | During the 6th to 12th years since diagnosis, 54% of BC survivors saw a cancer specialist (45.6% hematologist/oncologist, 11.3% radiation oncologist) and 19.9% saw a cancer-related specialist. 76% saw a primary care provider and 70.7% a medical specialist. | NS | NS |
Risendal 2015, USA [43] | NS | 68.5% indicated their main provider for after-cancer care was an oncologist. | BC survivors were 1.4 times more likely to have had a mammogram within the last 2 years (95% CI 0.5–3.8) | Women visiting an oncologist reported additional surveillance tests not recommended by ASCO compared with those visiting PCP or other: OR(chest x-ray) = 1.7, 95% CI 0.9–3.1 OR(imaging scan) = 1.2, 95% CI 0.7–2.1 OR(CBE) = 1.4, 95% CI 1.2–5.5 |
Urquhart 2017, Canada [44] | 51% of BC survivors had at least 1 routine follow-up visit. In terms of follow-up group, 49% had 0 visits and 21.2% had 5 or more. | Survivors of a gynecologic cancer had 48% more visits than BC survivors (IRR = 1.48, 95% CI 1.34–1.64) | NS | NS |
Wirtz 2014, USA [45] | NS | NS | Use of surveillance mammography declined through year 6 and became stable from year 7 to 10 (the median number of surveillance mammograms over the 10 years follow-up was 4). | Women with outpatient visits to primary care providers, an oncologist, or both had higher odds for undergoing surveillance than women seeing neither type of provider: [OR(oncologist only) = 1.55, 95% CI 1.16–2.08, OR(PCP only) = 1.33, 95% CI 1.11–1.59, OR(both) = 1.87, 95% CI 1.56–2.25]. |
Hsieh 2018, China [46] | NS | NS | NS | 49% of BC survivors reported taking calcium supplements, 6.1% reported taking vitamin D supplements and 27% reported having a bone density scan since being diagnosed with BC. |
Peuckman 2008, Denmark [47] | NS | BC survivors were more in contact with medical specialists, outpatient clinics, physiotherapists, chiropractors and “other doctor” in the last 3 months than the general population (SRR = 1.10, 95% CI 1.05–1.15). | NS | NS |
Van de Poll-Franse 2006, The Netherlands [48] | The proportion of BC survivors who visited a specialist was higher than in general population (53%; p < 0.001). Young BC survivors more often visited a physical therapist (56%; p < 0.01 vs 29%) and a complementary caregiver (26%; p < 0.05 vs 13%). Women with a higher well-being score contacted specialists less. | Having current problems as a consequence of cancer was significantly associated with visiting a primary care physician (OR = 2.8, 95% CI 1.1–7.0) and physical therapist (OR = 3.0, 95% CI 1.6–5.9) | NS | NS |
Weaver 2014, USA [49] | 32% of BC survivors did not receive follow-up visits in the past 2 years. Follow-up frequency differed significantly between patients who survived 4–9 years and 10–14 years after diagnosis (×2 = 9.31; p < 0.05) | In 64%, the main follow-up care physician was the oncologist or a cancer-related specialist. | NS | Activities associated with preventive care were commonly reported: 76.8% of the follow-up visits were due to screening for other cancers and 35.5% for non-cancer screening tests. |
Wiseman 2015, USA [50] | 77.8% of patients reported having had a routine check-up in the last year with their primary care physician and 77.8% reported receiving cancer follow-up instructions after cancer treatment. 75% reported that their primary care provider was the clinician most frequently providing care. | The < 6-year BC survivors were less likely to report a cancer-related clinician as the clinician who provided most of the care compared with the women diagnosed in the last 3 years or less: OR (2–3 years) = 2.55, 95% CI 1.43–4.55; OR (4–5 years) = 1.68, 95% CI 0.93–3.06. | NS | There are nationally recommended follow-up guidelines for BC survivors but the type of clinician that should provide care is not specified. |