BACKGROUND AND PURPOSE: 

• Most recurrences for Stage-1 cancer will occur during the first 3 years 
• Early detection of recurrence does not improve outcome or reduce morbidity  
• Previous studies reported one asymptomatic recurrence for every 653 routine outpatient appointments  
• Nurse led follow-up has been studied for breast and colorectal cancer 
• Beaver et al. (BJOG, 2018) assessed the value of nurse-led telephone follow-up (TFU) for patients with stage-1 endometrial cancer

METHODS: 

• Multicenter, randomized, non-inferiority trial (RCT) 
• Participants 
  • Women treated for stage -1 endometrial cancer attending hospital outpatient clinics for routine follow-up 
• Participants received either 
  • Traditional hospital-based follow-up (HFU) 
  • Nurse-led TFU 
• HFU arm 
  • First 2 years: 3 or 4 months  
  • 3 to 5 years: 6 monthly and annually 
  • >5 years: Care taken over by general practitioner  
• TFU arm 
  • Telephone intervention  
  • Gyn oncology nurse specialists  
  • Same intervals as HFU 
  • 20-minute calls focusing on physical, psychological, and social aspects of care 
• Primary outcomes  
  • Psychological morbidity (State Trait Anxiety Inventory, STAI-S)  
  • Patient satisfaction with information provided  
• Secondary outcomes  
  • Patient satisfaction with service | Quality of life | Time to detection of recurrence 
• Statistics 
  • Non-inferiority: Effectiveness for psychological morbidity, quality of life, and time to detection of recurrence 
  • Superiority: Patient satisfaction with information and service 
  • 80% power, at a 5% significance level

RESULTS: 

• 259 women were included in the study 
  • 129 TFU arm | 130 HFU arm  
• The STAI–S scores were similar between groups [mean (SD)] 
  • TFU 33.0 (11.0) and HFU 35.5 (13.0) 
• Estimated between‐group difference in STAI–S was 0.7; 95% CI, −1.9 to 3.3 
  • The confidence interval lies above the non‐inferiority limit (−3.5), indicating the non‐inferiority of TFU 
• There was no significant difference between groups in reported satisfaction with information; (P=0.83) 
  • Odds ratio (OR) 0.9; 95% CI, 0.4–2.1 
• Women in the HFU group were more likely to report 
  • Being kept waiting for their appointment (P=0.001) 
  • That they did not need any information (P=0.003) 
• Diagnosis of recurrence was not delayed by TFU 
  • All recurrences were symptomatic and interval events

CONCLUSION: 

• Nurse-led telephone follow-up was an effective alternative to traditional hospital based follow-up with stage-1 endometrial cancer patients

Learn More – Primary Sources: 

Comparing hospital and telephone follow-up for patients treated for stage–1 endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial

Related ObG Topics:

Endometrial Cancer: Beyond The Basics

Ovarian or Endometrial Cancer? Consider Lynch Syndrome

What is the Association Between Postmenopausal Bleeding and Risk for Endometrial Cancer?