A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Janine Dretzke*, Talhah Chaudri, Rishab Balaji, Hisham Mehanna, Paul Nankivell, David J. Moore, the PETNECK2 Research Team

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Downloads (Pure)

Abstract

Background: The traditional cancer follow‐up (FU) model for cancer survivors is by scheduled clinic appointments; however, this is not tailored to patient needs and is becoming unsustainable. Patient‐initiated follow‐up (PIFU) may be a more effective and flexible alternative. This systematic review aims to analyse all existing evidence from randomised controlled trials (RCTs) on the effectiveness of PIFU compared with other FU models that include routinely scheduled appointments in adults who have been treated with curative intent for any type of cancer.

Methods: Standard systematic review methodology aimed at limiting bias was used for study identification, selection and data extraction. MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and Epistemonikos were searched for systematic reviews to March 2022, and Cochrane CENTRAL was searched for RCTs from 2018 (April 2023). Ongoing trial registers were searched (WHO ICTRP, ClinicalTrials.gov, April 2023). Eligible studies were randomised controlled trials comparing PIFU with an alternative FU model in adult cancer survivors. Risk of bias assessment was via the Cochrane risk of bias tool‐2. Meta‐analysis was precluded by clinical heterogeneity and results were reported narratively.

Results: Ten RCTs were included (six breast, two colorectal, one endometrial cancer and one melanoma, total n = 1754); all studies had risk of bias concerns, particularly relating to how missing data were handled, and populations were unlikely to be representative. Limited findings in breast cancer suggested that type of FU does not affect recurrence detection or patient‐related outcomes, while PIFU may reduce the number of clinic visits. Adding patient‐led surveillance to routine FU may increase melanoma detection. Evidence for other types of cancer is too limited to draw firm conclusions.

Conclusions: PIFU may be a viable FU model in breast cancer, but further research is needed for other types of cancer and on long‐term outcomes. A protocol was registered with PROSPERO (CRD42020181424).
Original languageEnglish
Pages (from-to)19057-19071
Number of pages15
JournalCancer Medicine
Volume12
Issue number18
Early online date21 Aug 2023
DOIs
Publication statusPublished - Sept 2023

Keywords

  • cancer
  • patient‐initiated follow‐up
  • systematic review
  • randomised controlled trial

Fingerprint

Dive into the research topics of 'A systematic review of the effectiveness of patient‐initiated follow‐up after cancer'. Together they form a unique fingerprint.

Cite this