Title
Clinical practice guidelines for the care and treatment of breast cancer: 9. Follow-up after treatment for breast cancer (2005 update)
Authors
Eva Grunfeld, Sukhbinder Dhesy-Thind, Mark Levine Dr. Grunfeld is Professor of Medicine, Dalhousie University, and Director of Health Services and Outcomes Research, Cancer Care Nova Scotia, Halifax, NS. Dr. Dhesy-Thind is with the Cancer Care Ontario Juravinski Regional Cancer Centre and is Assistant Professor in the Department of Medicine, McMaster University, Hamilton, Ont. Dr. Levine is Professor in the Departments of Clinical Epidemiology and Biostatistics and of Medicine and is the Buffet Taylor Chair in Breast Cancer Research, McMaster University, Hamilton, Ont.
Organization
The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer* *The steering committee is part of Health Canada's Canadian Breast Cancer Initiative. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: Chair: Dr. Mark Levine (Cancer Care Ontario), Juravinski Regional Cancer Centre and McMaster University, Hamilton, Ont. Members: Dr. Penny Barnes, Queen Elizabeth II Health Sciences Centre, Halifax, NS; Dr. Judy Caines (Federal/Provincial/Territorial Advisory Committee on Health Services), Nova Scotia Cancer Centre, Halifax, NS; Dr. Beverley Carter (Health Care Corporation of St. John's), St. Clare's Mercy Hospital, St. John's, Nfld.; Dr. Eva Grunfeld (College of Family Physicians of Canada), Cancer Care Nova Scotia, Halifax, NS; Dr. Ivo Olivotto (BC Cancer Agency), Vancouver Island Cancer Centre and University of British Columbia, Victoria, BC; Dr. Carol Sawka, Cancer Care Ontario, Toronto, Ont.; Dr. Hugh Scarth (Atlantic Health Sciences Corporation), Saint John Regional Hospital, Saint John, NB; and Dr. Timothy Whelan (Cancer Care Ontario), Juravinski Regional Cancer Centre and McMaster University, Hamilton, Ont.
Patient guide
The patient guide, containing questions and answers for women on follow-up care, has also been updated and is available at www.cmaj.ca/cgi/content/full/158/3/DC1.
Objective
To provide information and recommendations to patients and their physicians regarding follow-up strategies and topics relevant to follow-up after treatment for breast cancer.
Evidence
Systematic review of the English-language literature retrieved from MEDLINE (1991 to January 2004). A nonsystematic review of the literature was continued through January 2005.
Validation
The original guideline was updated by a writing committee, which then submitted it for review, revision and approval by the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. The current update has been peer reviewed.
Sponsor
The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada.
Completion date
March 2005.
Method
The evidence reviewed for this document was obtained through a systematic review of the English-language literature retrieved from MEDLINE (1991 to January 2004). Search terms included "breast neoplasms," "follow-up," "randomized controlled trials," "meta analysis," "quality of life," "fatigue," "weight gain," "osteoporosis," "sexuality" and "pregnancy." A nonsystematic review of the literature and monitoring of major conferences on breast cancer were continued through January 2005. The quality of the evidence on which conclusions are based is categorized into 5 levels.2 The iterative process used to develop this guideline is described elsewhere.3 A writing committee updated the original guideline and submitted it to the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer for further review, revision and approval.
Status
This guideline updates the previously published guideline on follow-up after treatment for breast cancer.1 The evidence on the goals of follow-up and the components of the follow-up program are updated. As well, special topics of concern to breast cancer survivors, such as cognitive functioning, fatigue, weight management, osteoporosis, sexual functioning and pregnancy, are discussed. These topics were not included in the original 1998 version of the guideline. The topics of hormone replacement therapy (see guideline 14) and lymphedema (see guideline 11) are presented elsewhere.
References
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