Nurse-Led Follow-Up at Home vs. Conventional Medical Outpatient Clinic Follow-Up in Patients With Incurable Upper Gastrointestinal Cancer: A Randomized Study

Madeleen Uitdehaag, Paul Putten, Casper van Eijck, EML (Els) Verschuur, Ate van der Gaast, CJ (Chulja) Pek, Karin van der Rijt, Rob de Man, Ewout Steyerberg, RJF Laheij, PD (Peter) Siersema, Manon Spaander, Ernst Kuipers

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Context. Upper gastrointestinal cancer is associated with a poor prognosis. The multidimensional problems of incurable patients require close monitoring and frequent support, which cannot sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic. Objectives. To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal, pancreatic, or hepatobiliary cancer. Methods. Patients were randomized to nurse-led follow-up at home or conventional medical follow-up in the outpatient clinic. Outcome parameters were quality of life (QoL), patient satisfaction, and health care consumption, measured by different questionnaires at one and a half and four months after randomization. As well, cost analyses were done for both follow-up strategies in the first four months. Results. In total, 138 patients were randomized, of which 66 (48%) were evaluable. At baseline, both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits, whereas QoL and health care consumption within the first four months were comparable between the two groups. Nurse-led follow-up was less expensive than conventional medical follow-up. However, the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits. Conclusion. The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up. A cost utility study is necessary to determine the preferred frequency and duration of the home visits. J Pain Symptom Manage 2014; 47: 518-530. (C) 2014 U. S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)518-530
Number of pages13
JournalJournal of Pain and Symptom Management
Issue number3
Publication statusPublished - 2014

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