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For patients with early-stage breast cancer, treatment follow-up with nurse-led self-management sessions may be a viable alternative to physician visits, according to results of a phase III trial in the .

Lena Saltbæk, MD, PhD, of the Danish Cancer Institute in Copenhagen, and colleagues randomized 503 patients to either a nurse-led follow-up program consisting of a self-management intervention and patient-reported outcomes or a physician-led follow-up program.

At 2 years, patients in the intervention group reported significantly higher and clinically relevant quality-of-life (QoL) scores than those in the control group (75.69 versus 71.26, mean difference 5.05, 95% CI 3.30-6.79, P<0.001).

"The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in QoL," the researchers concluded. "The intervention group reported significantly less fear of recurrence, anxiety, and depression; they had fewer physician consultations but more nurse contacts and an unchanged diagnostic imaging pattern."

Saltbæk offered additional details and implications in the following interview.

In what ways does traditional physician follow-up not meet patients' needs?

Saltbæk: In the regular oncologist consultations, the main focuses are side effects to adjuvant endocrine therapy and a physical examination to screen for local or regional recurrence, which may potentially be curable. However, often there is not time to discuss the patient's concerns about resuming everyday life after cancer, including existential issues and fear of cancer recurrence. I believe we successfully address these issues in the multi-component MyHealth intervention with nurse-led follow-up.

What are the specifics of the nurse-led intervention?

Saltbæk: The intervention follow-up consisted of three elements, all delivered by experienced breast cancer nurses, who had received extra training before the study. After randomization, patients in the intervention group had 3-5 individual consultations with the project nurse during a 6-month period, focused on self-management and problem-solving, using the Guided Self-Determination method.

Furthermore, the patients reported symptoms regularly: every 3 months during the first year and every 6 months during the next 2 years. These patient-reported outcomes addressed symptoms potentially caused by recurrence as well as side effects of endocrine therapy and late effects of cancer and cancer treatment.

If any symptoms exceeded predefined thresholds, a project nurse would contact the patient. The nurse assessed the need for diagnostic imaging or the rotation of aromatase inhibitors. They advised the patient on symptom management and arranged a consultation with the project physician as needed.

The self-management intervention was developed specifically to identify challenges and the needs of each individual patient. The aim is to empower patients and promote self-care, and distinguish between bothersome but harmless symptoms and signs of recurrence. When the patients reported symptoms and were contacted by the nurses addressing their symptoms, the patients were further assisted in how to navigate these particular symptoms, limitations, and fears of cancer recurrence.

I believe the self-management intervention enhances patients' ability to benefit from a follow-up program based on self-reporting of symptoms and assisted by nurses' navigation, which helps patients adjust to life after cancer.

You are also evaluating detection of recurrence and survival outcomes. When do you plan to report that data?

Saltbæk: We will report recurrence and survival outcomes at 5- and 10-year follow-up, together with data on adherence to endocrine therapy. Unfortunately, the MyHealth study was not powered to find differences in these outcomes.

Is there anything else you want to make sure oncologists understand about this study?

Saltbæk: It is important to acknowledge that the intervention effect is a composite of the combined components: nurse-led follow-up, self-management using Guided Self-Determination, and responsive use of patient-reported outcomes.

It may seem possible to simply replace scheduled consultations with oncologists by nurse-led follow-up on demand. This is easily implemented in the clinic, is probably financially advantageous, and eliminates the challenges of certifying staff in the Guided Self-Determination method and of establishing a system for obtaining and reacting to patient-reported outcomes.

However, replacing an oncologist with an oncology nurse, or even a general practitioner, has already been examined without demonstrating similar improvements in quality of life, fear of recurrence, anxiety, and depression.

Read the study here and expert commentary about it here.