Cancer Follow-Up and Aftercare

As part of the Self-Management Workstream of the National Cancer Survivorship Initiative (NCSI), Macmillan Cancer Support, I conducted the following review:

‘Cancer Follow-Up: Towards a Personalised Approach to Aftercare Services. A Review of Current Practice and Selected Initiatives’ (Davies and Batehup, 2009).

The following findings were obtained for breast, colorectal, lung, and prostate cancer.

Breast Cancer

16 records were identified revealing a number of key findings within breast cancer follow-up, namely:

  • Intensive follow-up, as defined mostly in speciality acute settings by intensity of frequency of contact/biomedical tests/duration, was generally associated with higher costs with no benefits above those of minimal follow-up.

  • Telephone follow-up by nurses through patient-initiated contact, or through planned regular nurse contact, was associated with patient acceptability, satisfaction, and convenience, as well as with potential long-term reduced burden on hospital resources.

  • Patient-initiated follow-up was found to be acceptable to patients and healthcare providers, with there being no increase in the risk of timely detection of recurrence.

  • Radiographer-led follow-up was found to reduce number of clinic visits and show improvements in patient/clinician relationships.

  • There was increasing use of educational and self-management interventions alongside either patient-initiated follow-up or nurse-led telephone follow-up.

  • There was a lack of clarity as to the benefits of group-delivered follow-up interventions.

Colorectal Cancer

5 records were identified revealing a number of key findings within colorectal cancer follow-up, namely:

  • Intensive follow-up was generally considered to offer benefits in terms of detection of resectable recurrences, but at considerable cost.

  • More evidence was emerging that less intensive surveillance may offer acceptable safety.

  • Visits to GPs and oncology specialists were recommended above visits to only one, the reason being that preventive care services were more accessible if both professionals were consulted.

  • The use of positron emission tomography (PET) in the earlier detection of recurrence was being tested.

  • Some evidence was found for augmenting symptomatic patient-initiated surveillance in primary care with a combination of imaging in secondary care and biomarker testing in primary care; no clearly defined periods had been established.

  • There was emphasis on the range/combination/frequency of the role of biochemical/technological testing and examinations, on the earlier detection of resectable recurrences, leading to improved survival rates.

  • The focus was on surveillance through technology and biomarker testing, with little emphasis on other aspects of patient need as a cancer survivor.

Lung Cancer

2 records were identified that revealed a number of key findings within lung cancer follow-up, namely:

  • Ongoing studies were examining conventional follow-up with PET.

  • Nurse-led follow-up was found to be highly acceptable to patients and the healthcare service, resulting in less severe symptoms at 3, 6, and 12-months, as well as reduced hospital visits.

Prostate Cancer

5 records were identified that revealed a number of key findings within prostate cancer follow-up, namely:

  • There was a paucity of evidence on which to base the development of alternative approaches to the aftercare of men who are living with and beyond prostate cancer.

  • The follow-up care for men on hormone therapy often occurs unplanned and informally.

  • As with other cancers there was many variations in the delivery of follow-up, which raised concerns as to the impact of this variability on the patient experience.

  • Use of the internet in various formats as part of aftercare support (symptom monitoring) was becoming more influential.

  • Group follow-up was found to be demonstrating positive outcomes in terms of patient satisfaction, but more research is required in terms of detection of recurrence, increased survival, and patient acceptability.

An update of this review is currently underway and results will be available by the end of 2011.

Categories: Health

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