Should nurses conduct breast cancer follow-up visits?
Women report that current system is unsatisfactory
Hamburg, Germany: Women who have been treated for breast cancer find follow-up visits to their oncologists unsatisfactory and not reassuring, according to research carried out in Sweden.
Ingrid Kössler, president of the Swedish Association of Breast Cancer Societies, told the 4th European Breast Cancer Conference in Hamburg today (Thursday 18 March) that the format of follow-up visits needed to be changed and that research should be carried out into the efficacy of specialist nurses conducting the follow-ups.
Ms Kössler sent questionnaires to 1,200 members of three different local breast cancer organizations within the Swedish Breast Cancer Association, and also distributed it to participants in an Internet discussion forum. She received over 600 replies.
"The majority of the women preferred to go to a breast centre for follow-up visits rather than to their GP," said Ms Kössler. "However, they indicated that the follow-up examinations were hurried, investigations were not reassuring and some women reported a lack of continuity as they saw different oncologists at each visit. Many women felt there was no opportunity to ask questions, express emotional concerns or talk about their social situation.
"Other research has found that 70 to 80 per cent of recurrences have been detected by the patients themselves and this casts doubt on the effectiveness of follow-up visits with oncologists and surgeons and the use of routine investigations.
"It is important that the follow-up visits are changed to meet patients' ongoing needs better."
The rationale behind follow-up visits after primary treatment for breast cancer is that early detection of a recurrence leads to a better outcome, that women get a sense of psychological security and satisfaction from the visit, and that the data collected are useful for quality assurance. However, the visits are expensive and Ms Kössler said that if they are also ineffective in achieving their aims, a more efficient and cost-effective system needed to be put in place.
"Women who answered the survey said that they wanted more time for discussion and questions, and they wanted to see the same person at each visit," she said.
"The growing number of women diagnosed with breast cancer, in combination with improved treatment, increases the socio-economic burden of the disease. It is possible that if specially trained breast cancer nurses conducted the follow-ups, this could result in increased satisfaction among the breast cancer patients and a decreased cost of care.
"Although Sweden and other countries are conducting studies comparing nurse-led with conventional medical follow-up visits, we need more studies and trials to provide evidence-based information before we decide to change."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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