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After breast cancer patients complete the acute phase of their treatment (i.e. surgery, chemotherapy and/or radiation therapy), they are routinely followed in clinic every 3-6 months for several years. Multiple guideline recommendations exist with no consensus on the optimal follow-up schedule due to lack of randomized data to support any particular follow-up recommendation. Therefore the investigators propose a randomized trial evaluating personalized vs guideline-based well follow-up strategies for patients with early-stage breast cancer.
After breast cancer patients complete the acute phase of their treatment (i.e. surgery, chemotherapy and/or radiation therapy), they are routinely followed in clinic every 3-6 months for several years. Multiple guideline recommendations exist with no consensus on the optimal follow-up schedule due to lack of randomized data to support any particular follow-up recommendation. The frequency of follow-up varies between and within different institutions. To date, no de-escalation strategy has appropriately evaluated patient reported outcomes such as quality of life or perception of care. There has been a growing body of evidence that de-intensification of follow-up is safe, effective and reduces costs for both patients and the health care system. Therefore the investigators propose a randomized trial evaluating personalized vs guideline-based well follow-up strategies for patients with early-stage breast cancer.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| On-demand personalized follow-up care | Active Comparator | On-demand personalized follow-up care (on-demand access to a Wellness Beyond Cancer Program (WBCP) nurse and an annual follow-up by telephone with WBCP nurse following the patient's annual mammogram). Both groups of participants will have yearly mammograms (current standard of care) organized by their healthcare provider. |
|
| Guideline-based follow-up care | Active Comparator | Guideline-based follow-up care (i.e. current standard of care). Both groups will have yearly mammograms (current standard of care) organized by their healthcare provider. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| On-demand personalized follow-up care | Other | On-demand personalized follow-up care (on demand access to a WBCP nurse and an annual follow-up by telephone. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Health-Related Quality of Life | Health-Related Quality of Life as determined by the Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire. The FACT-G is a 27-item questionnaire designed to measure four domains of Health related quality of life (HRQOL) in cancer patients: physical, social, emotional and functional well-being. | 24 months after randomization |
| Measure | Description | Time Frame |
|---|---|---|
| Fear of recurrence | Fear of recurrence will be measured by the Functional Assessment of Cancer Therapy - Fear of Recurrence (FACT-FRQ) questionnaire. It consists of 3 questions suggested by David Cella at FACIT (Functional Assessment of Chronic Illness Therapy), that were adapted from Vickberg's Concerns about Recurrence (CARS) questionnaire. | 24 months after randomization |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mark Clemons, MD | Ottawa Hospital Research Institute | Principal Investigator |
| John Hilton, MD | Ottawa Hospital Research Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Ottawa Hospital Cancer Centre | Ottawa | Ontario | K1H8M2 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36922304 | Background | Beltran-Bless AA, Alshamsan B, Alzahrani MJ, Hilton J, Baines KA, Samuel V, Pond GR, Vandermeer L, Clemons M, Larocque G. Regularly scheduled physical examinations and the detection of breast cancer recurrences. Breast. 2023 Jun;69:274-280. doi: 10.1016/j.breast.2023.03.004. Epub 2023 Mar 8. | |
| 38194133 | Background |
| Label | URL |
|---|---|
| The Rethinking Clinical Trials (REaCT) website | View source |
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| Guideline-based follow-up care (standard of care) | Other | Follow-up care based on current standard of care guidelines. |
|
| Anxiety levels | Anxiety levels as determined by the Hospital Anxiety and Depression Scale (HADS) questionnaire. The HADS questionnaire measures anxiety and depression, which commonly coexist. It is comprised of seven questions for anxiety and seven questions for depression. | 24 months after randomization |
| Treatment related toxicity concerns | Treatment related toxicity concerns as assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) questionnaire. The FACT-ES questionnaire is a validated sub scale of the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. FACT-ES consists of 46 items on a 5 point Likert type scale ranging from 0 (not at all) to 4 (very much). It is designed to measure five domains of health: physical well-being, social/family well-being, emotional well-being, functional well being and endocrine symptom subscale. | 24 months after randomization |
| Recurrence-free survival | Measured by the number of participants free of breast cancer recurrence after 24 months of follow-up. | 24 months after randomization |
| Patient visits | Number of patient reported visits to different healthcare providers using a Patient Follow-up Questionnaire. The follow-up questionnaire consists of questions that assess the number of follow up visits a participant has had and also the type of healthcare provider the follow-up visits were with. | 24 months after randomization |
| Cost-effectiveness | Incremental cost-effectiveness rations (cost per one quality-adjusted life year (QALY) gained. | 24 months after randomization |
| Beltran-Bless AA, Larocque G, Brackstone M, Arnaout A, Caudrelier JM, Boone D, Fallah P, Ng T, Cross P, Alqahtani N, Hilton J, Vandermeer L, Pond G, Clemons M. The COVID-19 pandemic and its effects on follow-up of patients with early breast cancer: A patient survey. Breast Cancer Res Treat. 2024 Apr;204(3):531-538. doi: 10.1007/s10549-023-07232-3. Epub 2024 Jan 9. |
| 40014172 | Background | Beltran-Bless AA, Larocque G, Arnaout A, Caudrelier JM, Hilton J, Alqahtani N, Vandermeer L, Pond G, Clemons M. Evolving strategies for the routine follow-up of patients with early breast cancer and the impact of COVID-19: a survey of healthcare providers. Support Care Cancer. 2025 Feb 27;33(3):232. doi: 10.1007/s00520-025-09205-2. |
| 38320146 | Background | Beltran-Bless AA, Clemons M. How Frequently Should Patients with Breast Cancer Have Routine Follow-Up Visits? NEJM Evid. 2023 Aug;2(8):EVIDtt2300062. doi: 10.1056/EVIDtt2300062. Epub 2023 Jul 25. |
| 33813329 | Background | Surujballi J, Shah H, Hutton B, Alzahrani M, Beltran-Bless AA, Shorr R, Larocque G, McGee S, Cole K, Ibrahim MFK, Fernandes R, Arnaout A, Stober C, Liu M, Sienkiewicz M, Saunders D, Vandermeer L, Clemons M. The COVID-19 pandemic: An opportunity to rethink and harmonise the frequency of follow-up visits for patients with early stage breast cancer. Cancer Treat Rev. 2021 Jun;97:102188. doi: 10.1016/j.ctrv.2021.102188. Epub 2021 Mar 23. |
| 42041743 | Result | Beltran-Bless AA, Himmelman E, Kim A, Pond GR, Fallah P, Ng T, Hilton J, Savard MF, Larocque G, Baines KA, Primeau K, Saunders D, Allard D, Vandermeer L, Clemons M. A Randomized Trial Evaluating Personalized Versus Guideline-Based Well Follow-Up Strategies for Patients with Early Breast Cancer: Feasibility Outcomes. Curr Oncol. 2026 Apr 17;33(4):224. doi: 10.3390/curroncol33040224. |
| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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