Doctors 'ignore cancer guidance'

Mammograms can be part of follow-up checks

Specialists ignore guidance on how to monitor breast cancer patients in the years after treatment, a survey says.

The National Cancer Research Institute found many consultants failed to transfer patients' care swiftly back to GPs, citing safety concerns.

Writing in Annals of Oncology, Peter Donnelly, who questioned 562 UK cancer specialists, said the aims of the NHS Cancer Plan were "under threat".

A leading breast cancer charity called for more training for GPs and nurses.

It is a concern that breast cancer follow-up is becoming so devalued and de-regulated that it puts the UK's National Cancer Plan under threat Peter Donnelly National Cancer Research Institute

Patients who have had treatment for breast cancer need regular tests to make sure that the disease has not returned, and that they are coping well psychologically.

Drugs and treatment watchdog the National Institute for Health and Clinical Excellence (NICE) said in 2002 that routine monitoring of breast cancer patients who have been clear of disease for three years should be the responsibility of the GP surgery.

However, Mr Donnelly found many hospital consultants did not follow this guidance, with patients attending hospital for check-ups even several years later.

Little choice

He sent a questionnaire to 562 cancer specialists in the UK, asking them how this "follow-up care" was managed.

He found that while the majority of consultants had a formal plan for how follow-up patients were dealt with, only 9% of them had a plan that conformed with NICE guidance.

Only 18% of the specialists offered their patients any choice in how check-ups were carried out, and on average, patients were discharged back to the care of their GP five years after the all-clear, rather than three.

Mr Donnelly, who is a surgeon at Torbay Hospital in Devon, said that consultants said that they felt that many GPs did not have enough specialist knowledge to provide safe follow-up care.

GPs and community-based nurses also need adequate specialist cancer training Breast Cancer Care

He said: "This study shows that the NICE recommendations are not considered safe or acceptable by specialists, and that the majority of clinics are in breach of these guidelines.

"It is a concern that breast cancer follow-up is becoming so devalued and de-regulated that it puts the UK's National Cancer Plan under threat by providing neither the psychological support that patients need, nor the reliable data on which to base treatment plans."

He pointed out that follow-up care in hospital is more expensive to the NHS than care based at the GP surgery, and that the health service's struggle to fund new, expensive cancer drugs could be eased if improvements were made.

'Consultation process'

A spokesman for NICE said that the clinical guidelines on breast cancer follow-up represented "current best practice".

"While it normally takes clinical guidelines a while to bed down, as often, services have to be reconfigured to meet them, we would not expect them to be flouted completely.

"This guideline is now due for review, and we would be expecting the views of consultants as part of a consultation process."

A spokesman from charity Breast Cancer Care said that there was "clearly a discrepancy" between current NICE guidelines and what doctors actually did.

"This is reflected in what we hear from people with breast cancer about their own follow-up appointments," she said.

"Many have told us that they have concerns over the amount of information and support they get during appointments.

"GPs and community-based nurses also need adequate specialist cancer training, and keep up-to-date with treatment developments so they can deliver the long-term support that cancer patients need."

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