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Grand Rounds

Are Nurse-led Telephone Follow-Ups Sufficient for Stage-1 Endometrial Cancer Patients?

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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

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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?

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