Perspectives of health care professionals on the value of physical examinations for early detection of breast cancer recurrences: More than just a detection method?

Physical examinations (PE) detect relatively few recurrences after breast cancer treatment, but are still recommended in surveillance guidelines. This study explores Health Care Professionals (HCPs) perspectives on the frequency and value of PE. Semi-structured interviews were conducted in 11 Dutch hospitals with 22 HCPs involved in breast cancer follow-up. Interviews were coded by the framework methodology using the software Atlas.ti 23. Most HCPs occasionally deviated from the guideline, giving some patients more and others less PE than recommended. The majority attributed rather limited value to PE for detecting recurrences and all performed PE more often than they perceived valuable. More PE was performed to meet patients’ wishes, to evaluate treatment effects or to detect signals of recurrences which imaging cannot assess. Also the organization of consultations determined PE’s frequency. Performing less PE was mainly because of PE’s low detection rates of recurrences. HCPs seem aware of the low detection rates but still perform more PE than perceived as valuable to detect recurrences because of reasons other than detecting recurrences. Better information provision on PE’s limited value in detecting recurrences may prevent unrealistic expectations and unnecessary PE. Further evidence on the cost-effectiveness of PE is warranted to revise guidelines. • Healthcare professionals sometimes deviate from guidelines on physical examinations • More physical examinations are performed than perceived valuable to detect recurrences • Physical examinations are used to reassure patients and evaluate treatment effects • Patients need to be informed on respective functions of physical examinations • Effective use of physical examinations, also in aftercare, should be investigated