Breast cancer follow-up: a national survey of current clinical practice by the centers of Italian Oncological Group of Clinical Research (GOIRC).

Background: The number of breast cancer (BC) survivors is increasing due to the aging of the population and the improvement of survival rates. Survivors have health care needs including detection of early recurrences, treatment of therapy-related complications and psychological support. No randomized data exist to support any individual follow-up (FU) sequence or protocol. Pphysicians’ adherence to international guidelines is unknown. The aim of this study is to investigate the survivorship care plan in Cancer Centers affiliated to Italian Oncological Group of Clinical Research (GOIRC). Methods: A questionnaire survey with 12 questions was e-mailed to the members of GOIRC in March 2019. Respondents were asked how they follow-up BC survivors. We have collected the survey data and compared them to national/international guidelines. Results: 20 out of 30 GOIRC centers completed the survey. The majority of the oncologists (75%) reported to follow AIOM guideline in FU management. Although, 14 respondents (70%) are used to perform routinely tumor markers and imaging tests (chest X-ray and liver ultrasound) as screening tools for early detection of recurrence. Advanced imaging studies (bone scan, CT scan, PET/FDG CT) are routinely recommended in high-risk patients by 4 interviewed. Considering patients on aromatase inhibitors, all the respondents recommend lipid profile and bone density evaluation every two years. Moreover, nutritional counselling is offered in 7 centers (35%). Frequency of checkup is scheduled according with BC risk of relapse in 11 centers (55%), while visits are conducted six-monthly in the other 9 cases. Duration of FU is variable: 60% of interviewed monitor the patients until the end of the adjuvant endocrine therapy while in the other cases checkup is carried on over 10 years. At the end of oncology FU, all the interviewed recommended yearly mammography, in four cases annual tumor markers check is suggested too. Conclusion A majority of respondents in Italian Cancer Centers perform more intensive follow-up compared to guidelines recommendations. FU of BC survivors is still an unmet clinical need. Randomized national trial on survivorship care plan should be considered.