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Open Access Highly Accessed Study protocol

Improving the quality and efficiency of follow-up after curative treatment for breast cancer – rationale and study design of the MaCare trial

Merel L Kimman12*, Adri C Voogd3, Carmen D Dirksen4, Paul Falger5, Pierre Hupperets6, Kristien Keymeulen7, Marlene Hebly7, Cary Dehing1, Philippe Lambin128 and Liesbeth J Boersma128

Author Affiliations

1 Maastro Clinic, Maastricht, The Netherlands

2 Department GROW – MAASTRO, Maastricht University, The Netherlands

3 Department of Epidemiology, Maastricht University, The Netherlands

4 Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands

5 Department of Medical Psychology, University Hospital Maastricht, The Netherlands

6 Department of Medical Oncology, University Hospital Maastricht, The Netherlands

7 Department of Surgery, University Hospital Maastricht, The Netherlands

8 Department of Radiation Oncology, University Hospital Maastricht, The Netherlands

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BMC Cancer 2007, 7:1  doi:10.1186/1471-2407-7-1

Published: 2 January 2007



After curative treatment for breast cancer women frequently attend scheduled follow-up examinations. Usually the follow-up is most frequent in the first 2–3 years (2–4 times a year); thereafter the frequency is reduced to once a year in most countries. Its main aim is to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. However, the cost-effectiveness of these frequent visits is under much debate, leading to a search for less intensive and more cost-effective follow-up strategies.

In this paper the design of the MaCare trial is described. This trial compares the cost-effectiveness of four follow-up strategies for curatively treated breast cancer patients. We investigate the costs and effects of nurse-led telephone follow-up and a short educational group programme.


The MaCare trial is a multi centre randomised clinical trial in which 320 breast cancer patients are randomised into four follow-up strategies, focussed on the first 18 months after treatment: 1) standard follow-up; 2) nurse-led telephone follow-up; 3) arm 1 with the educational group programme; 4) arm 2 with the educational group programme. Data is collected at baseline and 3, 6, 12 and 18 months after treatment. The primary endpoint of the trial is cancer-specific quality of life as measured by the global health/QoL scale of the EORTC QLQ-C30. Secondary outcomes are perceived feelings of control, anxiety, patients' satisfaction with follow-up and costs. A cost-effectiveness analysis will be performed from a societal perspective.


Reduced follow-up strategies for breast cancer have not yet been widely applied in clinical practice. Improvement of psychosocial support and information to patients could lead to a better acceptance of reduced follow-up. The MaCare trial combines a reduced follow-up strategy with additional psychosocial support. Less frequent follow-up can reduce the burden on medical specialists and costs. The educational group programme can improve QoL of patients, but also less frequent follow-up can improve QoL by reducing the anxiety experienced for each follow-up visit. Results of the trial will provide knowledge on both costs and psychosocial aspects regarding follow-up and are expected in 2009.