Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Colorectal Dis. 2012 May;14(5):e245-9. doi: 10.1111/j.1463-1318.2011.02923.x.
Evidence suggests that follow-up after colorectal cancer improves survival. Colorectal cancer is so common that patient follow-up can overwhelm a service, affecting the ability to see new referrals and reassess patients seen previously who have new symptoms. In order to cope with this demand a nurse-led follow-up service was started in 2004. We aimed to review the results of a nurse-led colorectal cancer follow-up clinic.
Between 1 December 2004 and 31 January 2011, patients who underwent resection for colorectal cancer were followed up by a nurse specialist according to a protocol determined by the colorectal surgeons in the unit. All patient details were recorded prospectively in a purpose designed database.
Nine hundred and fifty patients were followed up over 7 years. Some 368 patients were discharged from the follow-up programme, 474 patients remain actively involved in the programme and 108 patients died. Of the patients discharged from the follow-up scheme 269 (73%) were discharged to their general practitioner free of disease after 5 years. Of the 108 who patients died, 98 were as a result of colorectal cancer. Twenty patients (2.1%) were identified with local (peri-anastomotic) disease recurrence and 93 patients (9.8%) were found to have developed distant metastatic disease. Of these, 65 patients (6.8%) were referred for palliative care and 28 (2.9%) had surgery for focal metastatic disease of whom 18 were still alive at the time of this analysis.
This paper shows that a nurse-led clinic for colorectal cancer follow-up can achieve satisfactory results with detection rates of recurrent or metastatic disease comparable to consultant follow-up. A nurse-led clinic provides the benefits of follow-up without overwhelming the consultant colorectal surgical clinic practice.
有证据表明，结直肠癌的随访可改善生存。结直肠癌非常常见，以至于患者随访可能会使服务不堪重负，从而影响对新转诊患者的诊治能力和对既往有新症状患者的重新评估。为了应对这一需求，我们于 2004 年启动了由护士主导的随访服务。我们旨在回顾由护士主导的结直肠癌随访诊所的结果。
在 2004 年 12 月 1 日至 2011 年 1 月 31 日期间，根据该单位的结直肠外科医生制定的方案，由专科护士对接受结直肠癌切除术的患者进行随访。所有患者的详细信息均前瞻性地记录在专门设计的数据库中。
在 7 年期间共对 950 例患者进行了随访。有 368 例患者从随访计划中出院，474 例患者仍积极参与该计划，108 例患者死亡。在出院的患者中，269 例（73%）在 5 年后无疾病复发且被转至其全科医生处。在死亡的 108 例患者中，98 例是结直肠癌所致。20 例患者（2.1%）被发现局部（吻合口周围）疾病复发，93 例患者（9.8%）被发现有远处转移疾病。其中，65 例（6.8%）被转至姑息治疗科，28 例（2.9%）接受了局部转移性疾病手术，其中 18 例在本分析时仍存活。
本研究表明，由护士主导的结直肠癌随访诊所可获得令人满意的结果，其检测复发或转移疾病的检出率与顾问随访相当。护士主导的诊所提供了随访的益处，而不会使结直肠外科顾问诊所的工作量过大。
