title: Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review.
abstract: OBJECTIVE
  This paper is a report of a systematic review of the effectiveness and cost-effectiveness of nurse-led follow-up for patients with cancer.
  
  
  BACKGROUND
  As cancer survivorship increases, conventional follow-up puts a major burden on outpatient services. Nurse-led follow-up is a promising alternative. Data sources. Searches were conducted covering a period from inception to February 2007 of 19 electronic databases, seven online trial registries, five conference proceedings reference lists of previous reviews and included studies.
  
  
  METHODS
  Standard systematic review methodology was used. Comparative studies and economic evaluations of nurse-led vs. physician-led follow-up were eligible. Studies comparing different types of nurse-led follow-up were excluded. Any cancer was considered; any outcome measure included.
  
  
  RESULTS
  Four randomised controlled trials were identified, two including cost analyses. There were no statistically significant differences in survival, recurrence or psychological morbidity. One study showed better HRQL measures for nurse-led follow-up, but one showed no difference, two showed a statistically significant difference for patient satisfaction, but two did not. Patients with lung cancer were more satisfied with nurse-led telephone follow-up and more were able to die at home. Patients with breast cancer thought patient-initiated follow-up convenient, but found conventional follow-up more reassuring. One study showed the cost of nurse-led follow-up to be less than that of physician-led follow-up, but no statistical comparison was made.
  
  
  CONCLUSIONS
  Patients appeared satisfied with nurse-led follow-up. Patient-initiated or telephone follow-up could be practical alternatives to conventional care. However, well-conducted research is needed before equivalence to physician-led follow-up can be assured in terms of survival, recurrence, patient well-being and cost-effectiveness.
authors.affiliation: Department of Primary Care & Public Health, North Wales Clinical School, School of Medicine, Cardiff University, UK. lewisr17@cardiff.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Lewis
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.forename: Nefyn H
authors.initials: NH
authors.lastname: Williams
authors.forename: Barbara
authors.initials: B
authors.lastname: France
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Maggie
authors.initials: M
authors.lastname: Hendry
authors.forename: Daphne
authors.initials: D
authors.lastname: Russell
authors.forename: Ian
authors.initials: I
authors.lastname: Russell
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
authors.forename: Nicholas S A
authors.initials: NS
authors.lastname: Stuart
authors.forename: David
authors.initials: D
authors.lastname: Weller
mesh_terms: D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D008495:Medical Oncology / Q000191:economics / Q000592:standards; D009369:Neoplasms / Q000191:economics* / Q000451:nursing; D009859:Oncology Nursing / Q000191:economics / Q000592:standards; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic