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Ezendam NPM, de Rooij BH, Creutzberg CL, Kruitwagen RFPM, van Lonkhuijzen LRPM, Apperloo MJA, Gerestein K, Baalbergen A, Boll D, Vos MC, van de Poll-Franse LV. Effect of reduced follow-up care on patient satisfaction with care among patients with endometrial cancer: The ENSURE randomized controlled trial. Gynecol Oncol 2024; 188:169-183. [PMID: 38970844 DOI: 10.1016/j.ygyno.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/05/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Evidence on the optimal follow-up schedule after endometrial cancer is lacking. The study aim was to compare satisfaction with care between women who received reduced follow-up care and women who received usual guideline-directed follow-up care for three years after surgery. METHODS The ENSURE (ENdometrial cancer SURvivors' follow-up carE) trial was a non-inferiority randomized controlled multicenter trial in 42 hospitals in the Netherlands. The intervention arm received reduced follow-up care (4 visits/3 years), while the control group received usual follow-up care (8-11 visits/3 years). Primary outcome was overall satisfaction with care, PSQIII score, over three years follow-up, with a non-inferiority margin of 6. Mixed linear regression, intention-to-treat and per-protocol analyses (presented below) were used. RESULTS Among 316 women included, overall satisfaction with care was not lower in the reduced follow-up (mean 82; SD = 15) compared with the usual follow-up group (mean 80; SD = 15) group (B = 1.80(-2.09;5.68)). At 6, 12 and 36 months, more women (93/94/90%) in the reduced follow-up group were satisfied with their follow-up schedule than in the usual follow-up group (79/79/82%; p < 0.001; p < 0.001; p = 0.050). CONCLUSIONS AND RELEVANCE Women with low-risk, early-stage endometrial cancer who received reduced follow-up care were no less satisfied with their care than women receiving usual follow-up care. Compared with usual follow-up, women in the reduced follow-up group had fewer clinical visits and, at the same time, more often reported being satisfied with their follow-up schedule. Findings suggest that reduced follow-up care may be the new standard, but should be tailored to meet additional needs where indicated.
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Affiliation(s)
- Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; CoRPS-Center of Research on Psychological disorders and Somatic diseases, Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Belle H de Rooij
- The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; CoRPS-Center of Research on Psychological disorders and Somatic diseases, Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, the Netherlands
| | - Luc R P M van Lonkhuijzen
- Amsterdam University Medical Centers, Center for Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Kees Gerestein
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Astrid Baalbergen
- Department of Obstetrics and Gynecology, Reinier de Graaf Group, Delft, the Netherlands
| | - Dorry Boll
- Gynecologic Oncologic Centre South, Department of Obstetrics and Gynecology, Catharina Hospital Eindhoven, the Netherlands
| | - M Caroline Vos
- Gynecologic Oncologic Centre South, Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; CoRPS-Center of Research on Psychological disorders and Somatic diseases, Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Chainrai M, Kershaw VF, Gray TG, Radley SC. Patient-initiated follow-up in gynaecology: Patient and clinician views. Eur J Obstet Gynecol Reprod Biol 2024; 298:18-22. [PMID: 38705009 DOI: 10.1016/j.ejogrb.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Follow-up appointments in the UK National Health Service account for up to two thirds of outpatient activity, but there is a significant resource impact in providing time fixed follow-up appointments. Increasingly patient initiated follow-up is being used, to make follow-up appointments work better for patients both in terms of timing and necessity, and to reduce unnecessary outpatient activity. The objective of this study was to use a modified questionnaire to evaluate patient and clinician views regarding Patient-Initiated Follow-Up (PIFU) in gynaecology services and identify subgroups suited to this pathway of care. STUDY DESIGN Participants including both patients and clinicians were recruited from a gynaecology outpatient department. Patients who have poorer access healthcare (with disabilities and black and ethnic minority background) were purposively targeted so their experiences could be included. Value and burden scores were evaluated using patient and clinician surveys based on a modified QQ-10 questionnaire which assessed perceived value and burden of patient initiated follow-up in gynaecology. Free text comments regarding PIFU were also collected. RESULTS 305 patients and 30 clinicians were surveyed. Overall response to patient initiated follow-up was positive. Patients and clinicians attributed high value (77.4 % and 81.4 %) and low burden scores (37.5 % and 44.7 %) to PIFU. Patient autonomy was cited as a reason for this by 84.6 % of patients and 93.3 % of clinicians. Patients attending benign gynaecological sub-specialties including endometriosis (84.2), general gynaecology (82.5) and vulval clinics (81.4) attributed the highest value scores. Gynaecology oncology patients attributed the lowest value (64.0) and highest burden score (51.3) of all subgroups. Younger adults (<60) were more likely to express a preference for PIFU (52.9 %) than older adults (≥60) (28.6 %). CONCLUSIONS In this study, both patients and clinicians are in favour of selected use of PIFU in gynaecology services. Both questionnaires found younger patients with benign gynaecological conditions were perceived as best suited PIFU. We recommend offering PIFU to select patients who are confident in self-monitoring, factoring patient choice so patients are not disadvantaged by this system. Further evaluation of PIFU in practice is needed before widespread implementation.
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Affiliation(s)
- Mira Chainrai
- University of Sheffield, Medical School, Beech Hill Road, Broomhall, Sheffield S10 2RX, United Kingdom
| | - Victoria F Kershaw
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, United Kingdom.
| | - Thomas G Gray
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, United Kingdom; University of East Anglia, Norwich, United Kingdom
| | - Stephen C Radley
- University of Sheffield, Medical School, Beech Hill Road, Broomhall, Sheffield S10 2RX, United Kingdom; Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, United Kingdom
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3
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Patel H, Drinkwater K, Stewart A. National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK. Clin Oncol (R Coll Radiol) 2024; 36:e146-e153. [PMID: 38548582 DOI: 10.1016/j.clon.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS The aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. MATERIALS AND METHODS An online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. RESULTS There were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices. Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years. 93% of respondents are interested in a national follow-up protocol. CONCLUSION Our data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.
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Affiliation(s)
- H Patel
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | | | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
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Rosato R, Ferrero A, Mosconi P, Ciccone G, Di Cuonzo D, Evangelista A, Fuso L, Piovano E, Pagano E, Laudani ME, Pace L, Zola P. Impact of different follow-up regimens on health-related quality of life and costs in endometrial cancer patients: Results from the TOTEM randomized trial. Gynecol Oncol 2024; 184:150-159. [PMID: 38309033 DOI: 10.1016/j.ygyno.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To investigate whether intensive follow-up (INT) after surgery for endometrial cancer impact health-related quality of life (HRQoL) and healthcare costs compared to minimalist follow-up (MIN), in the absence of evidence supporting any benefit on 5-year overall survival. METHODS In the TOTEM trial, HRQoL was assessed using the SF-12 and the Psychological General Well-Being (PGWB) questionnaires at baseline, after 6 and 12 months and then annually up to 5 years of follow-up. Costs were analyzed after 4 years of follow-up from a National Health Service perspective, stratified by risk level. The probability of missing data was analyzed for both endpoints. RESULTS 1847 patients were included in the analyses. The probability of missing data was not influenced by the study arms (MIN vs INT OR: 0.97 95%CI: 0.87-1.08). Longitudinal changes in HRQoL scores did not differ between the two follow-up regimens (MIN vs INT SF-12 PCS: -0.573, CI95%: -1.31; 0.16; SF-12 MCS: -0.243, CI95%: -1.08; 0.59; PGWB: -0.057, CI95%: -0,88; 0,77). The mean cost difference between the intensive and minimalist arm was €531 for low-risk patients and €683 for high-risk patients. CONCLUSION In the follow-up of endometrial cancer after surgery, a minimalist treatment regimen did not affect quality of life and was cost-saving in both low-risk and high-risk recurrence patients. As previous results showed no survival benefit, a minimalist approach is justified. The relevant proportion of missing data on secondary outcomes of interest could be a critical point that deserves special attention.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Italy; Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy.
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Andrea Evangelista
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Elisa Piovano
- SCDU Ginecologia e Ostetricia 2U, Ospedale Sant'Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO, Piemonte, Torino, Italy
| | - Maria Elena Laudani
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Luca Pace
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
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Sivarajah G, Snow H, Wilkinson MJ, Strauss DC, Smith MJ, Hayes AJ. Low local recurrence rates following marginal surgical resection of non-coelomic Atypical Lipomatous Tumours/Well-differentiated Liposarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107301. [PMID: 38041960 DOI: 10.1016/j.ejso.2023.107301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION High rates of local recurrence (LR) have been reported following resection of extremity Atypical lipomatous tumours/Well-differentiated liposarcomas (ALTs). This retrospective study of patients who underwent resection of primary deep extremity and trunk ALTs at a specialist sarcoma centre aims to assess morbidity and factors associated with low local recurrence rates (LRR). METHODS To review a homogeneous cohort of patients with low-grade disease, tumours with known high-risk histological features were excluded. Prognostic variables potentially influencing local recurrence (LR) (age, size, site, margin status, and histological findings) were analysed. Endpoints were LR, distant recurrence (DR) and local disease-free survival (LDFS). RESULTS 127 patients were identified, with median follow-up of 54 months (0-235). Median tumour size was 17.5 cm (5-36). 85 % occurred in the lower limb. 93.7 % underwent marginal resection. No patients received radiotherapy. Median hospital stay was 3 days (0-16). 7.9 % returned to theatre for evacuation of haematoma or infected seroma and 18.1 % had outpatient seroma aspiration. Surgical margins were R0/R1 in 93.7 % of patients and R2 in 6.3 % with a LR rate of 8.4 % and 75 % respectively at median time of 54 months. One- and 5-year LDFS was 100 % and 88.4 %, respectively. DR rate was 0.8 % (1/127) this patient had pleomorphic liposarcomatous transformation on recurrence and subsequently developed distant metastases. No patients died of disease. CONCLUSION Function-preserving marginal resection of non-coelomic ALTs has low morbidity, low LR and extremely low rates of distant relapse. Patients with lower limb ALT were found to have significantly lower LR, which may impact follow-up protocols.
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Affiliation(s)
- Gausihi Sivarajah
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Hayden Snow
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Michelle J Wilkinson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom.
| | - Dirk C Strauss
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Myles Jf Smith
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Andrew J Hayes
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
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Rulanda MC, Mogensen O, Jensen PT, Hansen DG, Wu C, Jeppesen MM. Patient-initiated follow-up in women with early-stage endometrial cancer: A long-term follow-up of the OPAL trial. BJOG 2023; 130:1593-1601. [PMID: 37277320 DOI: 10.1111/1471-0528.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A long-term follow-up of the OPAL trial to compare the effect of patient-initiated (PIFU) versus hospital-based (HBFU) follow-up on fear of cancer recurrence (FCR), quality of life (QoL) and healthcare use after 34 months of follow-up. DESIGN Pragmatic, multicentre randomised trial. SETTING Four Danish departments of gynaecology between May 2013 and May 2016. POPULATION 212 women diagnosed with stage I low-intermediate risk endometrial carcinoma. METHODS The control group attended HBFU with regular outpatient visits (i.e., 8) for 3 years after primary treatment. The intervention group underwent PIFU with no prescheduled visits but with instructions about alarm symptoms and options of self-referral. MAIN OUTCOME MEASURES The endpoints were FCR as measured by the Fear of Cancer Recurrence Inventory (FCRI) and QoL as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire C-30 (EORTC QLQ C-30), and healthcare use as measured by questionnaires and chart reviews after 34 months of follow-up. RESULTS FCR decreased from baseline to 34 months in both groups and no difference was found between allocations (difference -6.31 [95% confidence interval -14.24 to 1.63]). QoL remained stable with no difference in any domains between the two arms at 34 months using a linear mixed model analysis. The use of healthcare was significantly lower in the PIFU group (P < 0.01). CONCLUSION Patient-initiated follow-up is a valid alternative to hospital-based follow-up for people who have been treated for endometrial cancer and have low risk of recurrence.
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Affiliation(s)
| | - Ole Mogensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorte Gilså Hansen
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chunsen Wu
- The Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Odense, Denmark
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Dretzke J, Lorenc A, Adriano A, Herd C, Mehanna H, Nankivell P, Moore DJ. Systematic review of patients' and healthcare professionals' views on patient-initiated follow-up in treated cancer patients. Cancer Med 2023; 12:16531-16547. [PMID: 38771977 PMCID: PMC10469665 DOI: 10.1002/cam4.6243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/26/2023] [Accepted: 06/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Current follow-up models in cancer are seen to be unsustainable and inflexible, and there is growing interest in alternative models, such as patient-initiated follow-up (PIFU). It is therefore important to understand whether PIFU is acceptable to patients and healthcare professionals (HCPs). METHODS Standard systematic review methodology aimed at limiting bias was used for study identification (to January 2022), selection and data extraction. Thematic synthesis was undertaken for qualitative data, and survey findings were tabulated and described. RESULTS Nine qualitative studies and 22 surveys were included, mainly in breast and endometrial cancer. Women treated for breast or endometrial cancer and HCPs were mostly supportive of PIFU. Facilitators for PIFU included convenience, control over own health and avoidance of anxiety-inducing clinic appointments. Barriers included loss of reassurance from scheduled visits and lack of confidence in self-management. HCPs were supportive of PIFU but concerned about resistance to change, unsuitability of PIFU for some patients and costs. CONCLUSION PIFU is viewed mostly positively by women treated for breast or endometrial cancer, and by HCPs, but further evidence is needed from a wider range of cancers, men, and more representative samples. A protocol was registered with PROSPERO (CRD42020181412).
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Affiliation(s)
- Janine Dretzke
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ava Lorenc
- Bristol Medical School: Population Health Sciences, University of BristolBristolUK
| | - Ada Adriano
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Clare Herd
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and EducationUniversity of BirminghamBirminghamUK
| | - Paul Nankivell
- Institute of Head and Neck Studies and EducationUniversity of BirminghamBirminghamUK
| | - David J. Moore
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Amirthanayagam A, Boulter L, Millet N, McDermott HJ, Morrison J, Taylor A, Miles T, Coton L, Moss EL. Risk Stratified Follow-Up for Endometrial Cancer: The Clinicians' Perspective. Curr Oncol 2023; 30:2237-2248. [PMID: 36826134 PMCID: PMC9955652 DOI: 10.3390/curroncol30020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Risk-stratified follow-up for endometrial cancer (EC) is being introduced in many cancer centres; however, there appears to be diversity in the structure and availability of schemes across the UK. This study aimed to investigate clinicians' and clinical specialist nurses' (CNS) experiences of follow-up schemes for EC, including patient-initiated follow-up (PIFU), telephone follow-up (TFU) and clinician-led hospital follow-up (HFU). A mixed-methods study was conducted, consisting of an online questionnaire to CNSs, an audience survey of participants attending a national "Personalising Endometrial Cancer Follow-up" educational meeting, and qualitative semi-structured telephone interviews with clinicians involved in the follow-up of EC. Thematic analysis identified three main themes to describe clinicians' views: appropriate patient selection; changing from HFU to PIFU schemes; and the future of EC follow-up schemes. Many participants reported that the COVID-19 pandemic impacted EC follow-up by accelerating the transition to PIFU/TFU. Overall, there was increasing support for non-HFU schemes for patients who have completed primary treatment of EC; however, barriers were identified for non-English-speaking patients and those who had communication challenges. Given the good long-term outcome associated with EC, greater focus is needed to develop resources to support patients post-treatment and individualise follow-up according to patients' personal needs and preferences.
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Affiliation(s)
| | - Louise Boulter
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Nessa Millet
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Hilary J. McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Jo Morrison
- Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | | | - Tracie Miles
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Lorna Coton
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Esther L. Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- Correspondence:
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Patient initiated follow up in Obstetrics and Gynaecology: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 272:123-129. [PMID: 35303674 DOI: 10.1016/j.ejogrb.2022.02.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The demand for outpatient hospital appointments has risen steadily over recent years, almost doubling since 2008; now standing at 120 million appointments per year. Initiatives to reduce unnecessary appointments are a key area of interest, as they can be an effective way of both improving patient care and satisfaction, as well as reducing NHS costs. Patient Initiated Follow-Up (PIFU) provides an alternative to traditional hospital instigated follow-up, by which patients have autonomy in their future care, allowing them to make appointments based on their own perception of need. PIFU has proved successful when implemented in Rheumatology, Inflammatory Bowel Disease and Oncology, with trends towards reduced burden on outpatient appointments, improved patient satisfaction and lower costs. To-date, the use of PIFU in women's health has been limited to gynaecological oncology, where observations include high patient satisfaction and fewer appointments than traditional follow-up. This study aims to undertake a systematic review of the literature relating to PIFU in Obstetrics and Gynaecology in order to identify evidence-based indications for PIFU in the specialty, as well as form a foundation for a subsequent service evaluation. METHODS The project was registered with Prospero, University of York. Using the OVID platform, a literature search was conducted using the terms "patient initiated follow up", "gynaecology", "women's health", and "follow up care". Papers were then screened in accordance with the PRISMA protocol, and relevant articles identified based on our inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale, and data from the studies were extracted and compared. RESULTS Eight papers were identified as relevant, two were randomised controlled trials, three were retrospective cohort studies, and the remaining three were prospective cohort studies. The majority of these studies (5/8) were of good quality, scoring 6 or more points on the Newcastle-Ottawa Scale. Four of the eight studies examined cost-effectives; all reported cost-savings relating to PIFU. Seven of the eight studies also reported an association between PIFU and greater patient satisfaction, fewer overall appointments and reduced non-attendance. One study reported no effect on patient satisfaction. Five studies related to gynaecological oncology, two were obstetric and one urogynaecology. The studies which investigated PIFU use in selected gynaecological oncology patients reported that PIFU did not have a negative impact on detection of cancer recurrence, but evidence regarding the psychological impact of PIFU on cancer survivors was conflicting. CONCLUSION PIFU was received largely positively and was well accepted by women across these studies. It was also shown to be cost-effective, without a negative impact on health outcomes. PIFU also has the potential to offer additional benefits including reducing diagnostic delay and increasing patient engagement with their own health status. This review found a paucity of data for PIFU in Obstetrics and Gynaecology, with the exception of gynaecological oncology, and further evaluation is required before more widespread implementation.
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10
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Chhatwal K, Deighton AJ. Patient-initiated follow up as a means of reducing pressures in secondary care. Intern Med J 2022; 52:683-685. [PMID: 35419966 DOI: 10.1111/imj.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/18/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
Outpatient services, largely dedicated to routine follow up, have been under increasing pressure in recent years. The growing and ageing UK population has been a large driver of this pressure, requiring a significant increase in annual outpatient appointments. Many of these appointments, however, may be guided by organisational, rather than clinical need, and as a result, some evidence indicates patient attendance rates have fallen, demonstrating a need for more effective, patient-centred care models. One such model, patient-initiated follow up (PIFU) has shown significant promise, empowering patients while simultaneously reducing appointment numbers and increasing attendance rates. However, for PIFU to be implemented nationwide several key considerations must be made to ensure patients are appropriately engaged, and supported, in directing their own care.
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Affiliation(s)
| | - Alexander J Deighton
- School of Medicine, Barts and the London School of Medicine and Dentistry, London, UK
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Sarwar A, Van Griethuysen J, Waterhouse J, Dehbi HM, Eminowicz G, McCormack M. Stratified follow-up for endometrial cancer: a move to more personalized cancer care. Int J Gynecol Cancer 2021; 31:1564-1571. [PMID: 34795021 DOI: 10.1136/ijgc-2021-002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Hospital based follow-up has been the standard of care for endometrial cancer. Patient initiated follow-up is a useful adjunct for lower risk cancers. The purpose of this study was to evaluate outcomes of endometrial cancer patients after stratification into risk groupings, with particular attention to salvageable relapses. METHODS All patients treated surgically for International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA endometrial cancer of all histological subtypes, from January 2009 until March 2019, were analyzed. Patient and tumor characteristics, treatment details, relapse, death, and last follow-up dates were collected. Site of relapse, presence of symptoms, and whether relapses were salvageable were also identified. The European Society of Medical Oncology-European Society of Gynecological Oncology 2020 risk stratification was assigned, and relapse free and overall survival were estimated. RESULTS 900 patients met the eligibility criteria. Median age was 66 years (range 28-96) and follow-up duration was 35 months (interquartile range 19-57). In total, 16% (n=144) of patients relapsed, 1.3% (n=12) from the low risk group, 3.9% (n=35) from the intermediate risk group, 2.2% (n=20) from the high-intermediate risk group, and 8.7% (n=77) from the high risk group. Salvageable relapses were less frequent at 2% (n=18), of which 33% (n=6) were from the low risk group, 22% (n=4) from the intermediate risk group, 11% (n=2) from the high-intermediate risk group, and 33% (n=6) from the high risk group. There were only three asymptomatic relapses in the low risk patients, accounting for 0.33% of the entire cohort. CONCLUSIONS Relapses were infrequent and most presented with symptoms; prognosis after relapse remains favorable. Overall salvageable relapses were infrequent and cannot justify intensive hospital based follow-up. Use of patient initiated follow-up is therefore appropriate, as per the British Gynaecological Cancer Society's guidelines, for all risk groupings.
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Affiliation(s)
- Asma Sarwar
- University College London Hospitals NHS Foundation Trust, London, UK .,University College London, London, UK
| | | | | | | | - Gemma Eminowicz
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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Collins A, Taylor A, Guttery DS, Moss EL. Innovative Follow-up Strategies for Endometrial Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e383-e392. [PMID: 34172343 DOI: 10.1016/j.clon.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 06/01/2021] [Indexed: 01/22/2023]
Abstract
Increasing recognition of the heterogeneous nature of endometrial cancer, the excellent prognosis of low-risk cases and improvements in risk stratification offer opportunities for innovative, personalised follow-up strategies. This review article outlines the evidence base for alternative follow-up strategies in the different risk categories of endometrial cancer, cancer survivorship programmes and considers future directions in endometrial cancer follow-up, including emerging new techniques, such as the liquid biopsy, and opportunities for combining molecular and clinicopathological features to personalise endometrial cancer follow-up.
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Affiliation(s)
- A Collins
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - A Taylor
- Royal Marsden NHS Foundation Trust, London, UK
| | - D S Guttery
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - E L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
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