In a Danish single-institution phase III trial (MyHealth) reported in the Journal of Clinical Oncology, Saltbæk et al found that nurse-led individualized follow-up was associated with significantly better breast cancer–specific quality of life compared with usual care after completion of primary treatment for stage I to II breast cancer.
Study Details
The study included 503 patients enrolled at the Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, between January 2017 and January 2019. The center provides all oncologic treatments for breast cancer in Region Zealand, an area in Denmark which has a predominantly rural and low- to middle-income population. After completion of primary treatment, patients were randomly assigned to participate in a nurse-led intervention (n = 251) or usual care (n = 251). The nurse-led intervention consisted of three to five individual self-management sessions completed within 6 months after random assignment, regular reporting of symptoms, and navigation to health-care services. The usual care control group had regular outpatient visits with their physician.
The primary outcome measure was breast cancer–specific quality of life at 2 years, as measured by the Trial Outcome Index-Physical/Functional/Breast summary score of the Functional Assessment of Cancer Therapy-Breast; scores range from 0 to 96, with higher scores indicating better quality of life.
Key Findings
At 2 years, patients in the intervention group had a significantly and clinically relevant higher quality of life score vs the control group: mean scores were 75.69 ± 12.27 vs 71.26 ± 14.08, with a mean difference of 5.05 (95% confidence interval [CI] = 3.30–6.79, P < .001).
The intervention group also showed superior quality of life at 6 months (mean difference = 4.37, 95% CI = 2.67–6.08), 12 months (mean difference = 4.71, 95% CI = 3.00–6.42), and 36 months (mean difference = 4.91, 95% CI = 3.13–6.70).
For secondary outcome measures, at 6, 12, 24, and 36 months, the intervention group had significantly reduced fear of recurrence (P < .001 at all time points), anxiety (P < .001 at all time points), and depression (P = .011 to P < .001 across time points).
The intervention group had significantly fewer outpatient visits with physicians (370 vs 1,326, P < .001), more outpatient visits with nurses (101 vs 12, P < .001), and more telephone contacts with nurses (904 vs 125, P < .001.) No difference in use of total diagnostic imaging was observed (859 vs 908, P = .377).
The investigators concluded, “The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in quality of life.”
Lena Saltbæk, MD, PhD, of the Cancer Survivorship group, Danish Cancer Institute, Copenhagen, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Danish Cancer Society and others. For full disclosures of the study authors, visit ascopubs.org.
