Evolving strategies for the routine follow-up of patients with early breast cancer and the impact of COVID-19: a survey of healthcare providers

PurposeThe COVID-19 pandemic resulted in a shift from routine in-person follow-up for early breast cancer (EBC) to the increased use of virtual assessments. This survey explored healthcare providers’ (HCPs) perceptions around current practices and goals of follow-up.MethodsCanadian HCPs who treat EBC were contacted via an anonymous survey. Participants provided perspectives on follow-up, current practices, and interest in clinical trials assessing follow-up strategies.ResultsResponses were received from 73 HCPs including medical (n = 41/73, 56%), radiation (n = 13/73, 18%), and surgical oncologists (n = 13/73, 18%). Thirty-four percent (n = 25/73) of HCPs did not perform routine follow-up. Of the 48 (n = 48/73, 66%) who conducted in-person follow-up, it was typically 6-monthly for years 1–3, yearly until year 5, and then on-demand. Common reasons for follow-up visits were assessment of symptoms from endocrine therapy and for the detection of recurrent disease. HCPs felt routine follow-up with physical examination resulted in earlier detection of local (n = 16/48, 33%) and distant metastasis (n = 6/48, 12.5%). Forty-eight percent of HCPs felt that the transition to virtual visits would not impact either local or distant recurrence rates or overall survival. Sixty-nine percent (n = 33/48) will continue to follow patients with a combination of in-person and virtual appointments. Most respondents agreed that follow-up should be more individualized and risk adapted (n = 42/48, 87.5%). Most (62%, n = 29/47) expressed interest in performing trials assessing well follow-up strategies.ConclusionVirtual care will remain an integral part of routine follow-up. The effects of this on a range of patient outcomes should be explored in future trials.