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Nurses for breast cancer care follow up would save millions

Nurses are cheaper than doctors, and there is no difference in outcomes or patient experience, suggests research

OnMedica Staff

Friday, 18 April 2008

Millions could be lopped off the cost of breast cancer care if specialist nurses rather than doctors took responsibility for following up patients, suggests research presented today at the 6th European Breast Cancer Conference in Berlin.

The five-year study found that the cost of follow up care was €630 (£550.50) per person a year for patients who saw a doctor and €495 (£397) per person per year for those who saw specialist nurses.

Over five years this amounted to €866 (£695) per patient, which although modest, would enable add up to a substantial amount for a country’s healthcare budget, says Dr Inga Lill Koinberg, who is both a nurse and medical doctor at the Department of Research and Development, Hospital Varberg and Kristianstad University, Sweden.

The main difference in cost was explained by the number of visits to the doctor. There were 21% more contacts with doctors than with nurses, she said.

A further study on 264 breast cancer patients randomly allocated to either doctor led or nurse led follow up appointments, showed no difference in patients’ levels of anxiety and depression, their experience or recurrence or death rates.

The women were seen four times a year during the first two years, then examined twice a year for up to five years, and annually thereafter.

Patients in the nurse group saw a specialist nurse three months after the initial visit to the doctors following radiotherapy. They were told how to recognise a recurrence, and to phone the nurse if they had any questions or symptoms of cancer recurrence.

They also had an annual mammogram, and after three years were referred back to the routine breast cancer screening programme.

The cost difference added up to €900 (£722) per patient over five years. This might not sound much, but when added up, it would offer “a substantial opportunity for reallocating resources since breast cancer is the most prevalent tumour worldwide” said Dr Koinberg.

“The majority of women treated within the last five years attend a follow-up programme. Thus, in total, these follow-up programmes consume large resources, even if the individual patient consultation entails only limited expense,” added Dr Koinberg.


In a separate presentation, Jill Hervik, a physiotherapist and acupuncturist at the Vestfold Central Hospital Tønsberg, Norway, explained that acupuncture might provide effective relief from hot flushes in women treated with tamoxifen after surgery for breast cancer.

A small trial of 59 breast cancer patients given either 10 weeks of traditional Chinese acupuncture or sham (minimal) acupuncture showed that those given the acupuncture had a 50% reduction in hot flushes, both during the day and the night. This effect continued after the treatment stopped

 “Acupuncture has two advantages over other treatments for hot flushes: it is cheap and does not cause adverse side effects,” she said.

“Our results suggest that acupuncture could be used more widely for treating breast cancer patients suffering from symptoms related to their anti-oestrogen medication,” she suggested.



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