title: Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study.
abstract: BACKGROUND
  Upper gastrointestinal cancer is associated with a poor prognosis. The multidimensional problems of incurable patients require close monitoring and frequent support, which cannot sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic.
  
  
  OBJECTIVE
  To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal, pancreatic, or hepatobiliary cancer.
  
  
  METHODS
  Patients were randomized to nurse-led follow-up at home or conventional medical follow-up in the outpatient clinic. Outcome parameters were quality of life (QoL), patient satisfaction, and health care consumption, measured by different questionnaires at one and a half and four months after randomization. As well, cost analyses were done for both follow-up strategies in the first four months.
  
  
  RESULTS
  In total, 138 patients were randomized, of which 66 (48%) were evaluable. At baseline, both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits, whereas QoL and health care consumption within the first four months were comparable between the two groups. Nurse-led follow-up was less expensive than conventional medical follow-up. However, the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits.
  
  
  CONCLUSIONS
  The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up. A cost utility study is necessary to determine the preferred frequency and duration of the home visits.
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands. Electronic address: uitdehaag@go-spirit.nl.
authors.forename: Madeleen J
authors.initials: MJ
authors.lastname: Uitdehaag
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Paul G
authors.initials: PG
authors.lastname: van Putten
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Els M L
authors.initials: EM
authors.lastname: Verschuur
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Ate
authors.initials: A
authors.lastname: van der Gaast
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Chulja J
authors.initials: CJ
authors.lastname: Pek
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Carin C D
authors.initials: CC
authors.lastname: van der Rijt
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Man
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Robert J F
authors.initials: RJ
authors.lastname: Laheij
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Manon C W
authors.initials: MC
authors.lastname: Spaander
authors.affiliation: Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000379:methods* / Q000523:psychology; D000554:Ambulatory Care Facilities / Q000191:economics; D004938:Esophageal Neoplasms / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000191:economics / Q000523:psychology / Q000628:therapy*; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009859:Oncology Nursing / Q000191:economics / Q000379:methods*; D010166:Palliative Care / Q000191:economics / Q000379:methods / Q000523:psychology; D010190:Pancreatic Neoplasms / Q000191:economics / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Palliative care; advanced cancer; esophageal cancer; follow-up studies; gastrointestinal; health care costs; hepatobiliary cancer; nurse-led; pancreatic cancer; patient satisfaction; quality of life