A pilot study exploring the effect of discharging cancer survivors from hospital follow-up on the workload of general practitioners.
BACKGROUND
The tradition of routine, long-term follow-up of cancer patients in the outpatient clinic has led to busy clinics and long waiting times. Many cancer patients are anxious and have become dependent on the specialist clinic for reassurance. General practitioners (GPs) have been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonstrated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased demand on GP practices.


OBJECTIVE
To determine the consequences for GPs of discharging long-term cancer patients from a hospital outpatient follow-up clinic.


METHODS
A consecutive sample of 65 patients under annual review in a hospital oncology clinic were offered a planned discharge in which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depression rates were assessed using the Hospital Anxiety and Depression Scale (HADS) at the time of discharge and four months later at a home interview. The GPs of all patients who were discharged were sent questionnaires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity.


RESULTS
The results showed no significant increase in the consultation rates during the 12 months after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depression. GPs thought there was a need for more specialist Macmillan nurses working in the community and highlighted the importance of fast-track specialist referral.


CONCLUSIONS
Discharging this group of long-term cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the community suggests that primary care services may find it difficult to cope adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training requirements of GPs in the routine follow-up of cancer patients.
Wellhouse NHS Trust, Barnet, Herts.
I
I
Chait
R
R
Glynne-Jones
S
S
Thomas
D004739:England; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000628:therapy*; D010351:Patient Discharge; D010865:Pilot Projects; D017741:Survivors; D016526:Workload