The design and implementation of a specialist nurse-led program at Oxford University Hospitals in the United Kingdom focused on regular surveillance imaging follow-up of patients treated with surgery for early-stage lung cancer were presented at the 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer in Barcelona, Spain.1

Specifically, the program is for patients who have undergone resection for early-stage lung cancer and for whom adjuvant therapy has not been recommended or who have declined such treatment. It involves both face-to-face clinics and telephone clinics in which a specialist nurse with advanced practice skills communicates findings from computed tomography (CT) scans of the chest, abdomen, and pelvis obtained every 6 months for the first 2 years following surgery, and annually thereafter for an additional 3 years.1

“Prior to the introduction of the specialist nursing role, patients were reviewed by the junior doctors working in the clinic, offering limited continuity of care and often presenting challenges in following-up abnormal result[s],” the researchers noted.1

In contrast, in the nurse-led program, patients are followed by the specialist nurse who coordinates the program and also triages the patient based on the CT scan results.

“Abnormalities and concerns detected during the follow-up program are presented at the multidisciplinary meetings by the specialist nurse, who takes responsibility for the actions requested by the team,” the researchers commented.1

Furthermore, those patients meeting criteria for telephone communication, such as the ability to speak English and hear over the telephone, as well as the absence of cognitive impairment, receive surveillance imaging results by telephone if there are no abnormal findings or only minor changes requiring a repeat CT of the chest in 3 months.  

“The value to the patient is that they have a known point of contact, and they know they are being followed up,” noted Jenny Mitchell, nurse specialist and the study presenter, of Oxford University Hospitals and NHS Foundation Trust. Ms Mitchell also said that the possibility of having to travel to the hospital only once for each CT scan is another convenience for patients.2

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Patients “continue to receive continuity of care as the nurse who calls them is the same nurse who they saw at their first follow-up appointment in the face-to-face clinic,” Ms Mitchell explained.2

[The program] has also allowed our [physician] trainees to spend time training in clinic rather than having to work their way through follow-up lists, she added.2

From January 2013 to December 2017, 546 nurse specialist-led face-to-face patient appointments in 189 clinics were held. In the first 12 months following the introduction of the telephone clinic in April 2017, 254 patient appointments were held by the nurse specialist in 51 clinics.1   

References

1. Mitchell J, Belcher E. Establishing a nurse led follow-up service for patients with resected early stage lung cancer. Presented at: 2019 World Conference on Lung Cancer; September 7-10, 2019; Barcelona, Spain. Abstract PL03.01.

2. IASLC. Jenny Mitchell on her WCLC2019 research. https://www.youtube.com/watch?v=l3bW7ZpYac0. Accessed September 17, 2019.