title: Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial.
abstract: OBJECTIVE
  To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer.
  
  
  METHODS
  A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months.
  
  
  METHODS
  Outpatient clinics in two NHS hospital trusts in the north west of England
  
  
  METHODS
  374 women treated for breast cancer who were at low to moderate risk of recurrence.
  
  
  METHODS
  Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy).
  
  
  METHODS
  Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants' needs for information, participants' satisfaction, clinical investigations ordered, and time to detection of recurrent disease.
  
  
  RESULTS
  The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (-3.33 to 2.07) was within the predefined equivalence region (-3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228).
  
  
  CONCLUSIONS
  Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics.
  
  
  BACKGROUND
  National Cancer Research Institute 1477.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, UK. kinta.beaver@manchester.ac.uk
authors.forename: Kinta
authors.initials: K
authors.lastname: Beaver
authors.forename: Debbie
authors.initials: D
authors.lastname: Tysver-Robinson
authors.forename: Malcolm
authors.initials: M
authors.lastname: Campbell
authors.forename: Mary
authors.initials: M
authors.lastname: Twomey
authors.forename: Susan
authors.initials: S
authors.lastname: Williamson
authors.forename: Andrew
authors.initials: A
authors.lastname: Hindley
authors.forename: Shabbir
authors.initials: S
authors.lastname: Susnerwala
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.forename: Karen
authors.initials: K
authors.lastname: Luker
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D001007:Anxiety / Q000517:prevention & control; D001943:Breast Neoplasms / Q000451:nursing* / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000451:nursing / Q000517:prevention & control; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D019114:Remote Consultation / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome