Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review

Authors

  • Ruth Lewis,

    1. Ruth Lewis MSc Lecturer Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Richard D. Neal,

    1. Richard D. Neal PhD MRCGP Clinical Senior Lecturer Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Nefyn H. Williams,

    1. Nefyn H. Williams PhD MRCGP Clinical Senior Lecturer Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Barbara France,

    1. Barbara France Research Assistant Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Clare Wilkinson,

    1. Clare Wilkinson DA MRCGP Professor of General Practice & Director of Research Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Maggie Hendry,

    1. Maggie Hendry BA Research Fellow Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK
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  • Daphne Russell,

    1. Daphne Russell PhD Senior Research Fellow/Trial Statistician Institute for Medical and Social Care Research, Bangor University, UK
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  • Ian Russell,

    1. Ian Russell PhD FRCGP FRCP(Ed) Professor of Public Health Institute for Medical and Social Care Research, Bangor University, UK
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  • Dyfrig A. Hughes,

    1. Dyfrig A. Hughes PhD Reader Centre for Economics and Policy in Health, Bangor University, UK
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  • Nicholas S.A. Stuart,

    1. Nicholas S.A. Stuart DM FRCP Professor of Cancer Studies North Wales Clinical School, Bangor University, UK
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  • David Weller

    1. David Weller PhD MRCGP FRCP Professor of General Practice Department of General Practice, University of Edinburgh, UK
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R. Lewis: e-mail: lewisr17@cardiff.ac.uk

Abstract

Title. Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review.

Aim.  This paper is a report of a systematic review of the effectiveness and cost-effectiveness of nurse-led follow-up for patients with cancer.

Background.  As cancer survivorship increases, conventional follow-up puts a major burden on outpatient services. Nurse-led follow-up is a promising alternative.

Data sources.  Searches were conducted covering a period from inception to February 2007 of 19 electronic databases, seven online trial registries, five conference proceedings reference lists of previous reviews and included studies.

Review methods.  Standard systematic review methodology was used. Comparative studies and economic evaluations of nurse-led vs. physician-led follow-up were eligible. Studies comparing different types of nurse-led follow-up were excluded. Any cancer was considered; any outcome measure included.

Results.  Four randomised controlled trials were identified, two including cost analyses. There were no statistically significant differences in survival, recurrence or psychological morbidity. One study showed better HRQL measures for nurse-led follow-up, but one showed no difference, two showed a statistically significant difference for patient satisfaction, but two did not. Patients with lung cancer were more satisfied with nurse-led telephone follow-up and more were able to die at home. Patients with breast cancer thought patient-initiated follow-up convenient, but found conventional follow-up more reassuring. One study showed the cost of nurse-led follow-up to be less than that of physician-led follow-up, but no statistical comparison was made.

Conclusion.  Patients appeared satisfied with nurse-led follow-up. Patient-initiated or telephone follow-up could be practical alternatives to conventional care. However, well-conducted research is needed before equivalence to physician-led follow-up can be assured in terms of survival, recurrence, patient well-being and cost-effectiveness.

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