The Role of Regular Clinical Follow Up of Gynaecological Oncology Patients - a randomised controlled trial

Abstract

Aims: This study aims to assess clinical and psychosocial outcomes of telephone-based nurse follow-up in survivorship care of gynaecological malignancies in a Chinese population. Background: With increasing burden of survivorship care on specialist clinics, exploration on the feasibility of a nurse led telephone follow up system is needed. Methods: Women with endometrial or ovarian cancer who were attending regular post treatment follow up at a tertiary referral centre were randomised into two groups – Group 1 : Telephone follow up by nurses and Group 2 : Gynaecologists clinic follow up at a tertiary referral centre..Women in Group 1 were asked about their symptoms by telephone and taken through a QoL questionnaire (EORTC-QLQ 30) and HADS anxiety questionnaire. Those treated for ovarian malignancies also attend the hospital for CA125 measurement only. Women in Group 2 were followed-up by gynaecologists at a tertiary referral centre. They underwent symptoms review and physical examinations. Those with endometrial cancer also had vault smears taken while those with ovarian cancers had CA125 measured . They were also asked to complete a QoL questionnaire. Results: 385 women ,215 with endometrial and 170 with ovarian cancer , were randomized ( n= 191 and 194 in Group 1 and 2 respectively).There was no significant difference in the detection of recurrence by the two methods. However, patients in the nurse-led arm scored higher on emotional (88.5 vs 82.2; p=0.023) and cognitive functioning (86.4 vs 81.6; p =0.012) . Those in the gynaecologist-led arm scored higher on the HADS Anxiety Scale (3.55 vs 2.31; p=0.001) and were more likely to report symptoms. Conclusions: Our results demonstrate a preliminary non-inferiority of nurse-led follow-up, with improved psychological morbidity and quality of life. Thus, telephone nurse-led follow-up can be considered an effective substitute for hospital based care.