Abstract
PurposeIs patient-initiated follow-up, post-surgical treatment of early endometrial cancer safe and can it be used holistically to improve cardiovascular health? What are the cost implications of this model of follow-up?MethodsRetrospective data of 98 patients discharged to patient-initiated scheme since 2012. Service evaluation by anonymous patient feedback including physical health effects of the programme including weight loss. Financial cost was compared to traditional hospital-based follow-up over five years.ResultsNo evidence of recurrence over 54 months median follow-up in low-risk endometrioid endometrial cancer. Patient feedback indicates that the exercise course helped women reduce their BMI. Over one third women felt happier and one fifth felt more confident and had a better ability to cope with stress. Total of 91% patients would recommend this model of follow-up to friends or family in the same circumstance. European Society for Medical Oncology guidance suggests the number of hospital-based follow-up appointments required for this cohort would cost £109,760. Calculations in this paper examine the cost of patient-initiated follow-up and reflect an overall saving of around 96.5%.ConclusionThis service evaluation supports the claim that patient-initiated follow-up represents a safe alternative to the traditional hospital-based protocol. There is a potential for additional services to be offered to encourage and promote a healthy lifestyle linked to improving quality of life and cardiovascular survival following surgery for endometrial cancer.Implications for cancer survivorsCardiovascular morbidity is the most common cause of death in endometrial cancer survivors. Incorporating an exercise course as part of routine follow-up can help reduce this risk. The friendships formed by this communal follow-up can contribute towards emotional health and recovery. This holistic approach should be incorporated into novel follow-up strategies to help reduce patient BMI and reduce cardiovascular risk.
Highlights
The rising incidence of endometrial cancer is indicative of the global obesity pandemic: 40% of endometrial cancer cases are directly related to obesity and are
European Society for Medical Oncology guidelines suggest endometrial carcinoma follow-up is based on clinician evaluations combining history, physical and gynaecological examination every 3–4 months for the first two years, at six-month intervals until four years and a final annual check in the fifth year, [4] the focus being on detecting early recurrence
Most patients are motivated to engage with a change in lifestyle within the first six months following a cancer diagnosis [13].Thereby encouraging survivors to engage with weight loss services and physical activity is most likely to be successful in this window
Summary
The rising incidence of endometrial cancer is indicative of the global obesity pandemic: 40% of endometrial cancer cases are directly related to obesity and are preventable [1]. There are more women surviving endometrial cancer than ever before. Between 2018 and 2019 there were 229,345 gynaecology-oncology outpatient hospital followup appointments in England compared to only 10,000 during 2005–2006 [3]. This poses an increasing demand on health care resources. European Society for Medical Oncology guidelines suggest endometrial carcinoma follow-up is based on clinician evaluations combining history, physical and gynaecological examination every 3–4 months for the first two years, at six-month intervals until four years and a final annual check in the fifth year, [4] the focus being on detecting early recurrence
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