References
A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery
Abstract
Introduction: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. Methods: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations.
This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. Results: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. Discussion: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.
Colorectal cancer is the third most common cancer in the UK with over 40 000 cases in 2016 and the cost to the UK economy is estimated at £1.6 billion per year (White et al, 2018). Many of these cancers are treatable by surgical resection with or without adjuvant chemo- or radiotherapy, depending on the disease stage as well as other tumour and patient characteristics. The National Institute for Health and Care Excellence (NICE) recommends a clinic visit 4-6 weeks after resection for bowel cancer with curative intent (NICE, 2011). This should be followed by at least two CT scans of the chest, abdomen and pelvis in the first 3 years and regular blood tests. Colonoscopy should be offered at 1 year and considered at 5 years (NICE, 2011).
This is because evidence shows that serum carcinoembryonic antigen (CEA) and CT are the two investigations that increase the likelihood of detecting and therefore treating recurrence or metastatic disease (Association of Colproctology of Britain and Ireland (ACGBI), 2017). The Follow-up After Colorectal Surgery (FACS) study was a randomised clinical trial in 39 NHS hospitals that looked at follow-up in patients with bowel cancer who had undergone treatment with curative intent. It found that intensive CT scans or CEA screening compared to minimal follow-up increased the number of recurrences detected at an early stage by three times. The authors concluded that these investigations should be used in follow-up due to the increased number of early and treatable recurrences detected, but survival advantages between different follow-up strategies is likely to be small (Primrose et al, 2014).
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