Preferences for Follow-up After Treatment for Lung Cancer

Abstract

Pressure on lung cancer clinics is increasing with the "2-week wait" initiative. This initiative is one of the key targets set out in the National Health Service (NHS) Cancer Plan for the United Kingdom, whereby all patients presenting with symptoms which may be indicative of a cancer diagnosis will be seen by a consultant within 2 weeks of initial presentation at their primary care provider. This has resulted in busy clinics, with the potential for extended clinic waiting times and unmet needs for information and psychosocial support on the part of patients and families. There is increasing interest in the most appropriate mode of follow-up for patients with lung cancer who are under observation, many of whom have completed specific treatments. Such patients may benefit from specialist nurse review for symptom control and psychosocial support. Nurse-led clinics are safe and cost effective in the oncology and research-funded setting. This study aimed to assess the acceptability of nurse-led follow-up in a large general lung cancer clinic seeing approximately 250 new patients annually. Over a 34-week period, there were 487 follow-up attendances and 94 (19.3%) of these were made by 72 patients deemed eligible for nurse-led follow-up. Sixty patients were approached and 54 (90%) agreed to participate in the study. A questionnaire containing vignette scenarios of nurse-led, telephone, GP-led, and standard (hospital, medical) follow-up was completed by 34/54 (63%) of eligible patients, 10/20 (50%) carers, 20/31 (65%) staff, and 11/38 (29%) GPs. Respondents rated acceptability of the scenarios on a range of issues on a scale of 1 to 5. Patients also completed the EORTC QLQ C30 and lung module questionnaire. Subsequent interviews were carried out with samples of these respondent groups.Fatigue, dyspnea, cough, and pain were the most common general symptoms. Both standard and nurse-led follow-up scenarios were highly rated by patients and other respondents and both were highly significantly favored over GP follow-up, which was the least favored in all areas of the questionnaire. Telephone follow-up tended to elicit more polarized reactions, both positive and negative. In interviews, in relation to nurse-led follow-up, the importance of clear protocols, training, and easy access to medical review were highlighted.

Patient satisfaction with GP-led melanoma follow-up: a randomised controlled trial

“…In addition, it is clear that groups of health professionals, including GPs and specialist nurses, are willing, with certain caveats, to assume greater responsibility for the routine follow-up of patients with cancer (Grunfeld et al, 1995;Papagrigoriadis and Heyman, 2001;Moses et al, 2004;Cox et al, 2006). Our results seem to strengthen these findings, as they support the notion that GP-led follow-up would be attractive to a large proportion of individuals with melanoma, and their GPs.…”

Follow-up of cancer in primary care versus secondary care: systematic review

“…The perceived benefit of this is to facilitate diagnosis of recurrent disease, monitor the effectiveness and side-effects of treatment, manage comorbidity, and identify and treat psychosocial problems. [1][2][3][4] There is also evidence that patients value the psychological and social support that cancer follow-up provides, [5][6][7][8] and find it reassuring. [9][10][11] Conversely, hospital follow-up might also prompt unnecessary tests, raise anxiety, provide false reassurance, and delay the patient's return to full function.…”

Nurse led telephone follow up in ovarian cancer: A psychosocial perspective

“…However, discussions considering service redesign should primarily focus on improving the quality of service provision and the potential of nurses to enhance aspects of patient care. The acceptability of nurse led follow up has been demonstrated in a range of cancer sites including lung (Moore et al 2002;Cox et al 2006b), breast (Koinberg et al 2004), and prostate cancer (Faithfull et al 2001;Booker et al 2004). A qualitative breast cancer study of patient perceptions of routine follow up care (Pennery and Mallet 2000) reported that 54% of women questioned would prefer their follow up care to be provided by the nurse specialist as they were more 'supportive' and had the necessary 'time, skills and knowledge'.…”

“…In addition, the majority of patients (79%) reported feeling uncomfortable raising psychological and emotional concerns at their clinic appointment as they were conscious of taking up too much time. Nurse led follow up provides an opportunity for patients to discuss emotional and psychological concerns (Cox et al 2006b), and for nurses to utilise their specialist skills in providing holistic care.…”