| BackgroundBreast cancer is the most common cancer in women worldwide. It is also the principle cause of death from cancer among women globally. In spite of the high incidence rates, most of women diagnosed with breast cancer are still alive 5 years after their diagnosisthrough improvements in both screening and treatment.Therapy with tamoxifen and aromatase inhibitors for 5 years has been a mainstay of treatment for women with receptor-positive disease. While evidence indicates that chronic disease patients take only about half of their prescribed medications, breast cancer patients receiving endocrine therapy with tamoxifen and aromatase inhibitors, concern about adherence has recently been identified as well. Few studies have addressed adherence issues during long-term adjuvant hormonal treatment for breast cancer. Also, the studies reported the poor adherence of adjuvant hormonal treatment. Therefore, interventionsdesigned to manage the side-effects of endocrine therapy in order to increase adherence. An economic evaluation was performed alongside a randomised controlledtrial investigating the cost-effectiveness of nurse-led telephone follow-up instead of hospital visits inthe 18 monthsduring the period of breast cancer hormonal therapy.Aims1. To evaluatethe reliability and validity of the Chinese-version Beliefs about Medicines Questionnaire.2. SR is to determinine the effectiveness and cost-effectiveness of nurse-led telephone follow-up VS hospital follow-up for patients with cancer.3. The project aim to assess the effectiveness nurse-led telephone follow-up instead of hospital visits inthe 18 monthsduring the period of breast cancer hormonal therapy.4.An economic evaluation aims to determinethe most cost-effective follow-up strategy and assist resource allocation decisions.Methods1. The design was a cross-sectional questionnaire survey of people with breast cancer.And the reliability and validity of BMQ was test in 205 patients with breast cancer.2. Using the Cochrane Collaboration’s validated search strategies for identifying randomised controlled trials and reports of follow-up strategy, along with appropriate keywords and MeSH terms. Searches were conducted covering a period from inception to February 2014 of Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE,BMJ,EBSCO,MEDLINE,PBMED,Web of Knowledge,CBM and JBI.3. Arandomised controlled trial (RCT) design was performed among 311 early breast cancer patients with hormonal therapy. A self-design web-database wasdesigned for magnaging the patitents such as texting, reminding and mailing. Participants were randomised to follow-up care as usual (yearly outpatient clinic visits) or nurse-led telephone follow-up (monthly consultation with structured intervention).Telephone follow-up was performed by four trained breastcare nurses (BCN) and consisted of a semi-structured interview including managing the side-effects of endocrine therapyside-effects, compliance with hormonal therapy and an open discussion of these issues. The primary outcome forinterventions was measured by Medication Possession Ratio (MPR), Morisky self-reported Adherence Questionnaire (MAQ) and visual analogue scale (VAS). Secondary outcomes weremeasured by Functional Assessment of Cancer Therapy (FACT), Beliefs about Medicines Questionnaire (BMQ) and Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES).4.This economic evaluation (n= 311) compared the 18 months costs and the effects of two follow-up strategies:(1) hospital follow-up; (2) nurse-led telephone follow-up. Costs were measured using self-report and hospital registrations. Quality-adjusted life years (QALYs) weremeasured using the SF-6D. Outcomes were expressed in cost-effectivenessratios (CERs) and incremental cost-effectivenessratios (ICERs).Results1. The factor analysis of construct validity showed that 5 factors were extracted.The cumulative proportion was 55.422%. The Cronbach’s a was 0.738 for the total questionnaire. The overall necessity score (mean 12.2146, SD 3.0826) was higher than the concerns score (mean 12.1561, SD 2.4223), the difference was not statistically significant (p>0.005).2. Nine RCTs were identified in the review, three including cost analyses. In meta-analysis of six trials comparing nurse-led telephone to conventional follow-up about the quality of life, nurse-led telephone follow-up had no statistically significantly positive effect on the quality of life of patients with cancer (SMD=-0.17.95% CI[-0.36,0.01], p=0.06). Patients with cancer were associated with more satisfied with nurse-led telephone follow-up (SMD=0.6,95% CI [0.02, 1.18], p=0.04). Compared to conventional follow-up,the nurse-led telephone follow-up appear to reduce the risk of anxiety (MD=4.14,95% CI [0.12,8.17], p =0.04). One study showed telphone follow-up for breast cancer may reduce the burden on busy hospital clinics but will not necessarily lead to cost or salary savings. The others show that there were also significant cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care.3. The Nurse-led telephone follow-up did notsignificantly improve the qualityof life (P>0.05)at 3,6 and 18 months. The timing of the measurement of quality of life may be of significance to the response. No differences were seen inconcerns score(p >0.05) at 3,6 and 18 months. However, Patients in thetelephone arm were more likely to have higer in necessityscore during intervention. Meanwhile, compared to outpatient clinic visits, the nurse-led telephone follow-up appeared to enhance adherence (p< 0.05).Sexual hypoactivity, hectic fever, and weight gain were significantly improved in intervention group.4.Total medical costs were higher for nurse-led follow-up thanstandard follow-up, although this difference was not statistically significant (p>0.05). The nurse-led follow-up increased compliance rate by 5.3%, reduced 0.4 clinic visit, reduce the cost oftreatment side effects. Nurse-led telephone follow-up yielded most QALYs, and amounted to8936.25/QALY.Conclusion1. The simplified Chinese version of BMQ had a good reliability and validity. It can be used to evaluate the beliefs in a sample of early breast cancer with hormonal therapy.2. The results of this study indicate that nurse ledinitiatives can be used to reconfigure care to make itmore responsive to individual needs, increase patientsatisfaction, and reduce the burden of hospital visits. Any increase in cost is likely to bemodest. Nurse-led telephone follow-up could be practical alternatives to conventional care.3. Nurse-led telephone follow up appears to be an effective approachthat nurses can use to conduct astructured interview to enhance adherence.4.Nurse-led telephone follow-up seems an appropriate and cost-effective alternative to hospital follow-up for breast cancer patients during the period of breast cancer hormonal therapy. |
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