Papers

Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial

Sally Moore, research practitioner, ^a Jessica Corner, professor of cancer and palliative care, ^b Jo Haviland, statistician, ^a Mary Wells, research practitioner, ^a Emma Salmon, statistician, ^c Charles Normand, professor of health economics, ^d Mike Brada, reader and consultant in clinical oncology, ^e Mary O'Brien, consultant in oncology, ^e Ian Smith, professor of medical oncology. ^e

^a Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, ^b School of Nursing and Midwifery, University of Southampton, Southampton SO17 1BJ, ^c Clinical Trials and Statistics Unit, Section of Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, ^d Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1A 7HT, ^e Royal Marsden Hospital, Sutton, Surrey SM2 5PT

Correspondence to: J Corner j.l.corner{at}soton.ac.uk

Objective: To assess the effectiveness of nurse led follow up in the management of patients with lung cancer.
Design: Randomised controlled trial.
Setting: Specialist cancer hospital and three cancer units in southeastern England.
Participants: 203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months.
Intervention: Nurse led follow up of outpatients compared with conventional medical follow up.
Outcome measures: Quality of life, patients' satisfaction, general practitioners' satisfaction, survival, symptom-free survival, progression-free survival, use of resources, and comparison of costs.
Results: Patient acceptability of nurse led follow up was high: 75% (203/271) of eligible patients consented to participate. Patients who received the intervention had less severe dyspnoea at 3 months (P=0.03) and had better scores for emotional functioning (P=0.03) and less peripheral neuropathy (P=0.05) at 12 months. Intervention group patients scored significantly better in most satisfaction subscales at 3, 6, and 12 months (P<0.01 for all subscales at 3 months). No significant differences in general practitioners' overall satisfaction were seen between the two groups. No differences were seen in survival or rates of objective progression, although nurses recorded progression of symptoms sooner than doctors (P=0.01). Intervention patients were more likely to die at home rather than in a hospital or hospice (P=0.04), attended fewer consultations with a hospital doctor during the first 3 months (P=0.004), had fewer radiographs during the first 6 months (P=0.04), and had more radiotherapy within the first 3 months (P=0.01). No other differences were seen between the two groups in terms of the use of resources.
Conclusion: Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes.

What is already known on this topic Most patients with cancer are routinely seen in outpatient clinics for many years despite lack of evidence of effectiveness Doctors and nurses often fail to detect patients' emotional distress, and patients have little time to raise concerns What this study adds Follow up of patients with lung cancer by clinical nurse specialists is safe, acceptable, and cost effective Both patients and general practitioners were highly satisfied with the nurse led model of follow up