Feasibility and acceptability of follow-up for prostate cancer in primary care: a pilot study

Abstract

BackgroundThe number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care.AimTo test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up.Design & settingA feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort.MethodThe study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the ‘personalised care’ subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied.ResultsOf the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the ‘personalised care’ subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this.ConclusionThe new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.

Exploring the experiences of patients, general practitioners and oncologists of prostate cancer follow-up: A qualitative interview study

“…Providing primary care with access to the right information and education may help to alleviate this problem. One study developed a new protocol for follow up and found that the majority of patients were happy with primary care follow up (Heins et al, 2018). The key components of the system seemed to be clarification of the pathways for all aspects of follow up care including monitoring and re referral and giving clear and concise information about these processes to GPs.…”

“…The key components of the system seemed to be clarification of the pathways for all aspects of follow up care including monitoring and re referral and giving clear and concise information about these processes to GPs. GPs also had an easy access route back to oncology for queries if required (Heins et al, 2018).…”

“…These methods include the use of digital technology (Frankland et al, 2019;Nanton et al, 2017), nurse-led follow-up (Frankland et al, 2017) primary care based follow-up (Heins et al, 2018) and shared care approaches (Emery et al, 2014;Lund et al, 2016). Many of these approaches involve an element of shared care between several care providers which means the pathway is complex and information needs to be communicated to a number of different people (Heins et al, 2018). If the pathway is not robust then there is a potential for patients to become lost to follow up and possible recurrence may be missed.…”

Prostate cancer follow-up costs in Germany from 2000 to 2015

“…Therefore, it is recommended that follow-up expenses are included in cost-effectiveness evaluations of cancer treatments. Heins et al (2018) explored the feasibility of general practitioner (GP)-led prostate cancer follow-ups [51]. Most patients and physicians were satisfied with this new model.…”

Evaluation of the safety and effectiveness of prostate‐specific antigen (PSA) monitoring in primary care after discharge from hospital‐based follow‐up following prostate cancer treatment

“…There is agreement on the definition of PSA threshold indicative of recurrent disease, though they acknowledge the lack of evidence about timing and types of salvage treatment that should be offered (if any). Further recommendations in the European guide- Some studies have suggested that primary care led monitoring after discharge is safe and effective with good patient satisfaction rates (Goodall et al, 2017;Heins et al, 2018;Warr et al, 2016).…”