Impact case study database

Beaver’s work impacts on patients and health care staff in the North West of England, it has a national impact on policy and clinical guidelines, and an international impact in relation to the COVID-19 pandemic.

Patient Benefit*

Endometrial cancer is the fourth most common cancer in women and has increased by 57% over the last 30 years, directly linked to obesity. According to Cancer Research UK 2019, between 2014 and 2016 there were approximately 9,300 new diagnoses in the UK every year. Providing adequate support and follow-up for cancer survivors continues to stretch NHS resources. Beaver’s innovative approach to follow-up care for patients treated for endometrial cancer aimed to provide patients with the information they need to self-manage and to reduce the burden on hospital outpatient clinics. Patients receiving Telephone Follow-Up from specialist nurses were highly satisfied with the care and information received, and the service provided [1]. 78% reported receiving all the information they needed. The time to detection of recurrent disease was similar with five in each group. For the telephone group – there was a median of seven days and for the hospital group a median of nine days. Patients receiving Telephone Follow-Up saved time, money and had less time off work. The estimated return journey costs per patient for hospital consultations were GBP11.47, whilst productivity costs were approximately twice as high under Hospital Follow-Up [2]. Patients indicated that they preferred telephone to face to face hospital follow-up [3]. Telephone follow-up was convenient for patients, reassuring and promoted self-management [3]. Comments on the telephone service were overwhelmingly positive, primarily related to the convenience of the service, knowing who to contact if a problem arose, and being reassured by the consultation.

*“Very happy with the follow-up care. Preferred telephone appointments as long trips to the hospital weren’t necessary.” Patient ID 24 [4, A]

**“ *Overall very satisfied with telephone consultations. I have a contact number and am assured I can ring at any time with any queries I might have. This is something I would highly recommend.” Patient ID 06 [4, A]

Health Care Professional Benefit

Clinical nurse specialists gained satisfaction from fully utilising their skills and providing patients with the information they needed to self-manage. To date, specialist nurses have conducted hundreds of telephone appointments with patients and continue to receive positive feedback with high levels of patient satisfaction with the service. On trial completion, five hospitals in the North West region continued to provide nurse-led Telephone Follow-Up for patients treated for endometrial cancer (Lancaster, Barrow, Preston, Burnley, Blackpool) and report an intention to extend the service to other patients.

“I love it…, I think it's really, really good I, I really enjoy [it] and I look forward to doing the clinic and once the trials finished I certainly will carry on with it and I will see other patients as well so I will be extending the clinic [telephone] to suit all gynae patients rather than just endometrial.”* (Clinical Nurse Specialist 02) [J]

“The service is seeing more and more ladies with gynaecological cancers and more time is able to be allotted to these ladies due to the phone clinic … I find the clinic (telephone) efficient, less time consuming but as thorough as face to face and easy to perform.” Barbara Allton testimonial, Gynaecology Oncology Clinical Nurse Specialist, [B1]

Benefit to the NHS:

Currently, findings from the ENDCAT trial are referenced nationally as high-level evidence, Grade A [C]. It guides clinicians in follow-up service provision for patients diagnosed and treated for endometrial cancer. The British Gynaecology Cancer Society (BGCS) published national clinical guidelines in 2018 stating: ‘Alternative modes of follow-up such as telephone follow-up do not appear to be inferior to hospital-based follow-up, in terms of quality of life for stage I endometrial cancer’ [C, p36]. More recently, in 2019, Beaver was invited on to an expert panel meeting on gynaecological cancer follow-up. The panel recommended implementation of remote monitoring including Telephone Follow-Up for intermediate and high-risk endometrial cancer patients, thus extending our inclusion criteria. Furthermore, Telephone Follow-Up was also extended to the new patient group of ovarian cancer patients. These recommendations will inform revised national clinical guidelines for the follow-up care of gynaecological cancer patients [D].

Testimonials from senior clinical staff indicate the reach and significance of our work:

*“Telephone follow-up is now delivered across the UK and beyond with the evidence base delivered by UCLAN’s department of oncology nursing. This mode of cancer care is supported by Macmillan and other patient focused organisations. This is the preferred choice by patients as it is delivered at home and delivered by specialist nurses who know the patients and can spend more time discussing their holistic needs…Professor Beaver’s work has changed the landscape of follow-up care in the UK and provided the robust evidence to support this.” Dr Pierre Martin-Hirsch, Gynaecology Oncologist, President of the British Society of Colposcopy and Cervical Pathology . [B2]

We received recognition of the importance of our work in the field of nursing, the largest health care workforce in the NHS, when the ENDCAT research and clinical team were shortlisted for the prestigious RCNi awards [E].

International reach

Patients with cancer can be in an immunosuppressed state due to treatment. As such, they are high risk in terms of morbidity and mortality during the COVID-19 pandemic. As hospitals globally are considered a source for contracting the virus, face to face appointments have been cancelled or replaced with alternative forms of follow-up, including Telephone Follow-Up. Hence, our work on Telephone Follow-Up is now likely to have an even greater impact, providing evidence on the effectiveness of this approach. Academic papers and reports are already being published that reference our work (Simcock et al 2020, Kang et al 2020); [F, G]. Simcock et al (2020) describe a consensus meeting of 121 global participants with recommendations to implement Telephone Follow-Up to lower the risk of COVID 19 transmission during cancer treatment and follow-up [F]. A paper published in the United States, referencing our work, reports on the importance of telemedicine during the COVID-19 pandemic for head and neck cancer patients [G]. A report published by the Australian government defining a policy framework for the management of patients with cancer during the pandemic [H] makes repeated reference to the Simcock et al. (2020) paper. Although only recently published, the findings from the ENDCAT trial have been referenced as supporting evidence in the Cancer Care Ontario (Canada) guidelines for Follow-up after Primary Therapy for Endometrial Cancer [I].

One practitioner commented that Beaver’s research was “…making a difference to women effected by breast cancer in this pandemic as we've adapted to offer information, support and the opportunity to discuss their needs using experience and knowledge from your research.” [B3]