When and how to discharge cancer survivors in long term remission from follow-up: the effectiveness of a contract.

This study aimed to examine a formal planned system of discharge from the oncology clinic of a district general hospital for long term cancer survivors. The mainstay of this system lay in a written contract between the doctor and the patient, which accepted continuing responsibility after discharge. During a 6-month period, 65 consecutive cancer patients who were in long-standing remission were interviewed and offered discharge according to the terms of the contract. Of these, 41 accepted and signed the contract. At 4 months postdischarge, patients were visited in their homes and their views sought on the effectiveness of the contract in terms of reassurance and their experience of being discharged after so many years of follow-up care. At a median interval of 13 months (range 6-18), six patients have returned to the clinic. The remaining 35 patients appeared to be successfully rehabilitated to primary care. Anxiety and fear that recurrence would not be detected were the major factors associated with refusal to accept the discharge contract.