Finally, Frank Johnson quite persuasively discussed the need for better evidence in terms of long-term follow-up. We now have a very limited data set to direct clinicians in terms of what follow-up strategies they should use. Randomized trials are needed, and these may turn out to be very cost saving if we found out that we did not need to do as much testing and evaluation. His call to action is that we need support for these kind of trials.

Jerry Yates from the ACS made an interesting and important point that with the low event rates in Eva Grunfeld’s trial (3.5 percent of women with breast cancer had any kind of serious event in their prospective follow-up) it is very, very hard, even in a very reasonably large randomized trial, to see anything meaningful. He proposed as potentially useful using administrative databases to obtain exposure information associated with treatment, and then look at outcomes across large populations. Another idea is to conduct focused studies on groups with high-risk exposures.

Sandra Horning, again made a very important plea for the value of linking these kinds of research studies to clinical trial populations, where again, we know exactly what the treatment exposures are, and then looking at them long-term, particularly if we could have biological specimens to look at risk and genetic DNA repair of genes, and so forth in terms of subgroups of individuals who may be at risk for late effects.

And again, these are all issues I think that we feel passionately about. The real challenge for all of us is finding the resources, perhaps again, collaborative work, trying to work together, dealing with existing cohorts, existing opportunities, and finding ways to leverage them. Thank you.

Dr. Greenfield: Thank you to all of our moderators, and thank you all. The meeting is adjourned.

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