Introduction: Patients post definitive surgical or radiological prostate cancer management warrant regular ongoing follow-up, contributing to the clinical burden and cost of medical care in a social health care service. Commonly, patients return for face-to-face clinical appointments. However, self-management in suitably counselled patients via a telephone-based nurse led follow-up instead, empowers patients to manage their own recovery. We investigated the outcomes of prostate cancer patients from our protocol-based virtual PTFU clinic.
Methods: PTFU has been established at the University Hospital Southampton NHS Foundation Trust and six trust supported cancer sites since 2014. Over a period of 6 years (2014-2019), eligible patients were accrued to a nurse led virtual prostate cancer clinic. The follow-up interval and blood based PSA testing were tailored to include a 3 monthly telephone consultation in the first 2 years, 6 monthly for two years thereafter and annually until a minimum of 5 years had been reached. PSA tests were done quarterly. The calculated follow-up cost was £47 for nurse led telephone clinics and £74 for face-to-face outpatient consultant reviews. The patients on the nurse-led pathway were aware that a recurrence of measurable PSA and/or clinical symptoms would prompt a clinic consultation.
Results: Currently 1085 (160-200 annually) patients are enrolled in the PTFU programme. 437 radical prostatectomy patients joined the programme at a median of 13.7 months (IQR 4.9-39.0) post-surgery for median of 36.6 months (IQR 19.8-55.7). 31 (7%) patients were recalled and 5 (1%) patients were discharged. Similarly, 487 radiotherapy patients were accrued at a median of 13.2 months (IQR 5.0-38.9) post treatment and remained on the programme for a median of 39.8 months (IQR 21.3-51.3). 43 patients returned to clinic and 10 patients were discharged. In total 22 patients passed away while on the programme from non-prostate cancer related causes. Based on our model by implementing PTFU the overall cost of clinic follow-up is reduced by more than a third to £126,900.
Conclusions: PTFU is a clinically safe and patient accepted protocol guided follow-up regime. Apart from the financial benefits for both patients and the social healthcare system, it is convenient for patients and empowers them to seek help when appropriate. Source of
