Nurse or surgeon follow-up after rectal cancer: a randomized trial.
OBJECTIVE
Follow-up programmes consume a large amount of resources with less time for the surgeon to take on new patients. The aim of this randomized study was to compare patient satisfaction, resource utilization and medical safety in patients curatively operated for rectal cancer who were followed up by either a surgeon or a nurse.


METHODS
The nurse was trained by the colorectal surgeon before the start of the study. Curatively operated patients were asked to give their consent to participate. Randomization was performed by the stoma therapist. After each consultation, the patient completed a questionnaire.


RESULTS
A total of 110 patients (58 men) age 68 (range 41-87) years were included between 2002 and 2005. Only three patients refused participation. Patient satisfaction was high according to the Visual Analogue Scale (VAS): 9.4 for the surgeon and 9.5 for the nurse (NS). Consultation time was longer for the nurse: 24 vs 15 min (P = 0.001), with more blood samples being taken (29%vs 7%, P = 0.002). Radiological investigations exceeding the routine were made in 11%vs 4% (NS) cases. Surgical assistance was needed in 13 of 182 consultations with the nurse [mean 6 (1-15) min, total 75 min]. Distant metastases were detected in seven patients in the surgeon group and eight in the nurse group (P = 0.953). Total costs of follow-up did not differ.


CONCLUSIONS
Patient satisfaction was equally high for the specialist nurse as for the colorectal surgeon. On only a few occasions was surgical assistance necessary and total costs for the follow-up showed no difference. Medical safety appeared uncompromised. Nurse-led follow-up is encouraged.
Strand
E
E
Colorectal Unit, Department of Surgery and Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.
Nygren
I
I
Bergkvist
L
L
Smedh
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009859:Oncology Nursing / Q000191:economics; D017060:Patient Satisfaction; D012004:Rectal Neoplasms / Q000191:economics / Q000451:nursing* / Q000473:pathology / Q000601:surgery*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome