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The was conducted in breast cancer patients in the surveillance phase with the aim of studying the effectiveness of a nurse-led intervention protocol. The control group had routine outpatient biannual physician visits, whereas the intervention group had nurse-led interventions comprised of self-management sessions of regular reporting of symptoms and navigation to healthcare services. Very high-risk patients were not included in the study.

The nurse-led intervention group experienced higher quality of life, less anxiety, depression, and fear of recurrence. There were more nurse contacts and less physician consultation in the intervention group. The study was conducted in Næstved, Denmark in a rural, low- to middle-income population, from 2016 to 2019 with a 3-year follow-up.

Currently, our surveillance guidelines recommend 3 to 4 visits per year in the first 5 years following early breast cancer treatment, followed by annual visits thereafter. However, there has been a lack of evidence on how effective these clinical visits are in detecting recurrences and making a meaningful difference in improving survival.

It's important to note that in Denmark, where the study was conducted, usual surveillance care has been changed in recent years, and non-high-risk patients are seen only twice in the first year after treatment, and after the first year are given the option of no having regular contact or having nurse consults for rehabilitation needs.

The study made adjustments to the usual-care group to continue biannual follow-up appointments to align with international practice guidelines. One could make the argument that the usual-care group had less scheduled opportunities to touch base with their healthcare team compared with the intervention arm, which therefore led to more worries about recurrence and more anxiety.

The study shows that a nurse-led intervention helps significantly with improvement in quality of life and anxiety scores in the survivorship phase. The guided self-determination method and nurse interventions described in the study could be a useful addition in our current survivorship programs.

The study, however, does not address if there was a difference in survival outcomes between the groups. The lack of head-to-head studies showing non-inferiority in survival outcomes with alternative surveillance methods will make it hard for us to completely do away with our current protocol of physician outpatient visits, and replace it with patient symptom reporting/nurse-led intervention-based surveillance.

But this is an important area of research that needs to be done, as we may be able to allocate our healthcare resources in meaningful ways, given the rise in cancer survivors and the increasing lack of oncologists to meet the needs of our healthcare system.

We also need more research addressing improved surveillance strategies. Ongoing circulating tumor DNA research could hopefully change the landscape of cancer surveillance by detecting recurrences earlier and translating it into better survival benefits.

Rosana Gnanajothy, MD, is a breast medical oncologist and hematology oncology physician.

Read the study here and an interview about it here.