Follow-up care

I was scared to finish treatment because I became attached to the nurses and doctors who looked after me. They became my second family. – Larissa

Once you have finished active treatment (surgery, chemotherapy and/or radiotherapy), your doctor will make recommendations about your follow-up care. Follow-up care involves physical examinations and scans aimed at identifying whether breast cancer has come back or if there is a new breast cancer. Follow-up care appointments also provide you with an opportunity to talk to your doctor about any ongoing side effects of treatment or other concerns you are experiencing.

The recommendations made by your doctor about your follow-up care will be specific to your individual circumstances. You will receive information about how often you should have check-ups and scans such as a mammogram and/or ultrasound.

Follow-up care may be provided by one or more of your specialists and/or your GP. There has been increasing recognition that GPs are well placed to play a key role in providing follow-up care. ‘Shared care’ is a model that involves specialists and GPs working together to provide follow-up care for women who have completed active treatment for breast cancer.

At check-ups, your doctor will talk to you about your scan results, any treatment-related side effects you are experiencing and any concerns you have. Your  Follow-up care specialist will support your GP to provide this care. If there are any signs of a possible recurrence of breast cancer, your GP can refer you directly and quickly back to your specialist.

To explore whether a shared care approach was appropriate for women following active treatment for early breast cancer, Cancer Australia conducted the Shared care demonstration project. As part of the project,  shared follow-up care between cancer specialists and GPs was implemented at five breast cancer services in Australia.

An evaluation found that shared care is safe and effective.

There are a number of benefits for women using the shared-care model. GPs can provide more holistic care than a specialist, given their knowledge of your  overall health and family situation. For women in rural areas, it can mean less travel time if you are able to have your appointments with your local GP, rather than at a cancer centre in another town or city.

The Cancer Australia Statement – Influencing best practice in breast cancer recommends that shared follow-up care be offered to women with early breast cancer. BCNA is working with Cancer Australia to ensure this model meets our members’ needs.

Shared care models have been implemented in other countries, including Canada and the United States.

Some women tell us they experience challenges with their GP. It is very important you find the right GP for you. Taking a list of questions to check-ups can help you remember concerns you had between appointments. You may have questions about side effects, such as fatigue, joint pain, lymphoedema or menopausal symptoms.

Your doctor will be able to help you manage treatment-related side effects or point you to information or services that may assist. If you notice a new symptom or changes to your breasts between check-ups, it is always important to make an appointment with your doctor.

After active treatment, it is natural and very common to worry about breast cancer coming back. Let your doctor know if you are experiencing a lot of fear and anxiety. We have videos and fact sheets on our website to help with fear of recurrence.

Sometimes BCNA receives enquiries from women asking why they are not offered body scans or extra tests as part of routine follow-up care. Clinical trials and research studies have found that more intensive follow-up does not improve the length or quality of life of women affected by breast cancer compared with standard follow-up care. Extra tests may be recommended if it is thought cancer may have returned.

Research has found that physical activity and maintaining a healthy diet after active treatment can improve physical and emotional wellbeing. Studies have also found that exercising regularly and limiting your alcohol intake may reduce the risk of cancer coming back. We have booklets about healthy eating and physical activity on our website.

Tips for follow-up care:

  • Find the right GP for you.
  • Keep a diary of any issues you may be experiencing – physical or emotional.
  • Tell your doctor about any physical problems, such as fatigue, lymphoedema or weight gain.
  • Tell your doctor about any emotional problems you are experiencing, such as anxiety or constant worry.
  • Talk to your doctor about any relationship or sexual function issues.
Issue 81
Summer 2017