title: Follow-up of prostate cancer patients by on-demand contacts with a specialist nurse: a randomized study.
abstract: OBJECTIVE
  The effectiveness of traditional follow-up programs and the intensive search for disease progression in men with prostate cancer have been questioned. The aims of this randomized multi-centre study were to evaluate medical safety, patient satisfaction and resource utilization in an on-demand follow-up by a specialist nurse compared with traditional follow-up by a urologist.
  
  
  METHODS
  Four hundred consecutively approached men with newly diagnosed or previously known prostate cancer in any stage at three hospitals in Sweden were randomized to follow-up in the nurse group (NG, 200 patients) or the urologist group (UG, 200 patients). In the NG, the nurse contacted the patient by phone every 6 months unless the patient himself initiated the contact. Patient satisfaction was evaluated twice a year via questionnaire. The questionnaire included the validated Hospital Anxiety and Depression Scale (HADS). The costs of all medical interventions and adverse events related to prostate cancer were calculated for all patients.
  
  
  RESULTS
  Medical safety, measured as complication frequency and lag time from symptoms to intervention, during the first 3 years of the observation period, was similar in the NG and the UG. The total number of interventions due to symptoms from prostate cancer was also similar in both groups. The analysis of accessibility and the HAD scale showed no significant differences between the groups. The mean outpatient cost (excluding pharmaceutical costs) per patient was lower in the NG compared to the UG, especially among patients without metastases at inclusion (37% lower cost).
  
  
  CONCLUSIONS
  Our study indicates that men with prostate cancer can be safely followed up by a specialist nurse. The study results show that this alternative follow-up is cost-effective, especially in men without metastases.
authors.affiliation: Department of Urology, Orebro Medical Centre, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Helgesen
authors.forename: S O
authors.initials: SO
authors.lastname: Andersson
authors.forename: O
authors.initials: O
authors.lastname: Gustafsson
authors.forename: E
authors.initials: E
authors.lastname: Varenhorst
authors.forename: B
authors.initials: B
authors.lastname: Gobén
authors.forename: S
authors.initials: S
authors.lastname: Carnock
authors.forename: L
authors.initials: L
authors.lastname: Sehlstedt
authors.forename: P
authors.initials: P
authors.lastname: Carlsson
authors.forename: L
authors.initials: L
authors.lastname: Holmberg
authors.forename: J E
authors.initials: JE
authors.lastname: Johansson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009720:Nurse Clinicians / Q000191:economics; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000191:economics / Q000451:nursing* / Q000473:pathology