Follow-up care after treatment for prostate cancer: evaluation of a supported self-management and remote surveillance programme

Jane Frankland,Deborah Cooke,Jake Jordan,Ines Mesa-Eguiagaray,Alison Richardson,Rebecca Foster,Hazel Brodie,Heather Gage,Claire Foster,Ruth Pickering

doi:10.1186/s12885-019-5561-0

Abstract

BackgroundAlternative models of cancer follow-up care are needed to ameliorate pressure on services and better meet survivors’ long-term needs. This paper reports an evaluation of a service improvement initiative for the follow-up care of prostate cancer patients based on remote monitoring and supported self-management.MethodsThis multi-centred, historically controlled study compared patient reported outcomes of men experiencing the new Programme with men experiencing a traditional clinic appointment model of follow-up care, who were recruited in the period immediately prior to the introduction of the Programme. Data were collected by self-completed questionnaires, with follow up measurement at four and eight months post-baseline. The primary outcome was men’s unmet survivorship needs, measured by the Cancer Survivors’ Unmet Needs Survey. Secondary outcomes included cancer specific quality of life, psychological wellbeing and satisfaction with care. The analysis was intention to treat. Regression analyses were conducted for outcomes at each time point separately, controlling for pre-defined clinical and demographic variables. All outcome analyses are presented in the paper. Costs were compared between the two groups.ResultsSix hundred and twenty-seven men (61%) were consented to take part in the study (293 in the Programme and 334 in the comparator group.) Regarding the primary measure of unmet survivorship needs, 25 of 26 comparisons favoured the Programme, of which 4 were statistically significant. For the secondary measures of activation for self-management, quality of life, psychological well-being and lifestyle, 20 of 32 comparisons favoured the Programme and 3 were statistically significant. There were 22 items on the satisfaction with care questionnaire and 13 were statistically significant. Per participant costs (British pounds, 2015) in the 8 month follow up period were slightly lower in the programme than in the comparator group (£289 versus £327). The Programme was acceptable to patients.ConclusionThe Programme is shown to be broadly comparable to traditional follow-up care in all respects, adding to evidence of the viability of such models.

Highlights

For men who have been treated for prostate cancer this includes physical needs, such as urinary and bowel problems and hot flushes, and psychological needs related to sexual dysfunction [5,6,7]
This paper reports the evaluation of a service improvement initiative for men who have completed treatment for prostate cancer
Analysis Programme effectiveness Descriptive statistics were used to compare baseline clinical and demographic characteristics of the programme and comparator groups, as well as to compare those completing both 4 and eight-month follow-up questionnaires with those lost to attrition

Summary

Introduction

Introduction to support workerSet up on PSA tracker system PSA ReviewsSigned up to Online PortalConducted Electronic Health Needs Assessment (HNA) 2.8Conducted Paper Health Needs Assessment (HNA)Staff Member electronic MessagesPatient electronic MessagesCost of delivery of workshop (per patient)Comparator group follow up care costs Face to Face CLINIC, CNS Band Face to Face CLINIC, CNS Band Face to Face CLINIC, CNS Band8A Face to Face CLINIC, Registrar Urology Face to Face CLINIC, Consultant Urology Face to Face CLINIC, Registrar Oncology Face to Face CLINIC, Consultant Oncology Telephone CLINIC, CNS Band Telephone CLINIC, CNS Band Telephone CLINIC, CNS Band8A Telephone CLINIC, Consultant OncologyUnplanned Clinical calls cost Telephone Contact, Support worker Telephone Contact, CNS Band Telephone Contact, CNS Band Telephone Contact, CNS Band8A Telephone Contact, Registrar Urology Telephone Contact, Consultant Urology Telephone Contact, Consultant OncologyOther prostate related service use GP Visit GP Tel Advice GP Home Visit. This paper reports an evaluation of a service improvement initiative for the followup care of prostate cancer patients based on remote monitoring and supported self-management. The common approach to cancer follow-up care, of routine clinic/office-based appointments for all patients at pre-specified intervals, does not always lead to these needs being addressed [8, 9]. The increasing numbers of cancer survivors in follow-up care over a long period of time means a system of review involving direct contact for all patients is unsustainable in resource constrained health care systems such as the British National Health Service (NHS). The recommended model for delivery of this self-management focussed pathway is a collection of interventions including holistic needs assessment, treatment summaries, rapid re-access to specialised care when indicated, and patient education and support [12]. There has been recognition of the relevance of such an approach to other international contexts [13]

Methods

Results

Discussion

Conclusion