Alternative models of cancer follow-up care are needed to ameliorate pressure on services and better meet survivors' long-term needs. This paper reports an evaluation of a service improvement initiative for the follow-up care of prostate cancer patients based on remote monitoring and supported self-management.
This multi-centred, historically controlled study compared patient reported outcomes of men experiencing the new Programme with men experiencing a traditional clinic appointment model of follow-up care, who were recruited in the period immediately prior to the introduction of the Programme. Data were collected by self-completed questionnaires, with follow up measurement at four and eight months post-baseline. The primary outcome was men's unmet survivorship needs, measured by the Cancer Survivors' Unmet Needs Survey. Secondary outcomes included cancer specific quality of life, psychological wellbeing and satisfaction with care. The analysis was intention to treat. Regression analyses were conducted for outcomes at each time point separately, controlling for pre-defined clinical and demographic variables. All outcome analyses are presented in the paper. Costs were compared between the two groups.
Six hundred and twenty-seven men (61%) were consented to take part in the study (293 in the Programme and 334 in the comparator group.) Regarding the primary measure of unmet survivorship needs, 25 of 26 comparisons favoured the Programme, of which 4 were statistically significant. For the secondary measures of activation for self-management, quality of life, psychological well-being and lifestyle, 20 of 32 comparisons favoured the Programme and 3 were statistically significant. There were 22 items on the satisfaction with care questionnaire and 13 were statistically significant. Per participant costs (British pounds, 2015) in the 8 month follow up period were slightly lower in the programme than in the comparator group (£289 versus £327). The Programme was acceptable to patients.
The Programme is shown to be broadly comparable to traditional follow-up care in all respects, adding to evidence of the viability of such models.
BMC cancer. 2019 Apr 23*** epublish ***
Jane Frankland, Hazel Brodie, Deborah Cooke, Claire Foster, Rebecca Foster, Heather Gage, Jake Jordan, Ines Mesa-Eguiagaray, Ruth Pickering, Alison Richardson
University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK. ., University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK., University of Surrey, School of Health Sciences, Guildford, Surrey, GU2 7XH, UK., Department of Clinical and Experimental Medicine, University of Surrey, Surrey Health Economics Centre, Guildford, Surrey, GU2 7XH, UK., University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Nine Edinburgh BioQuarter, Teviot Place, Edinburgh, EH8 9AG, UK., University of Southampton, Faculty of Medicine, Highfield, Southampton, SO17 1BJ, UK., University of Southampton, School of Health Sciences and University Hospital Southampton NHS Foundation Trust, Highfield, Southampton, SO17 1BJ, UK.