Nurse‐led renal cell carcinoma clinic: a single center review
Background In 2015 our centre introduced a nurse‐led renal cell cancer follow‐up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ‐confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow‐up processe...
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| Veröffentlicht in: | ANZ journal of surgery 2024-06, Vol.94 (6), p.1071-1075 |
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| creator | Thia, I. Tan, A. Botha, E. Picardo, A. Brown, M. Thyer, I. Abdul‐Hamid, A. Tan, A. Teichmann, D. Hayne, D. McCombie, S.P. |
| description | Background
In 2015 our centre introduced a nurse‐led renal cell cancer follow‐up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ‐confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow‐up processes.
Objectives
The primary objective was to assess the effectiveness of a nurse‐led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.
Patient and Methods
All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk‐stratification and theoretical outcomes between the protocols.
Results
After a mean follow up period of 31.2 months (range 0–77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi‐disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re‐stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x‐ray (CXR) in this cohort and our protocol tended to place patients in higher risk‐stratification groups as compared to current EAU guidelines.
Conclusion
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of |
| doi_str_mv | 10.1111/ans.18920 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2934277086</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2934277086</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3130-ab6646dbcebdc2343b1ae681da12c0261fcb02a5c53aa30bd50f5dc860c144ca3</originalsourceid><addsrcrecordid>eNp10E1LwzAYB_AgipvTg19ACl700C0vbdp6kTF8A5kH9Ryepk8lo2tnsjp28yP4Gf0kZnZ6EMwhCeTHnzx_Qo4ZHTK_RlC7IUszTndIn0VRHHKWJbvbO4uE6JED52aUMimzeJ_0RBpxKVLeJ5fT1jr8fP-osAgs1lAFGiu_gdWmbuYQ6MrURl8EEDhTv1To3-slWo_fDK4OyV4JlcOj7Tkgz9dXT5Pb8P7h5m4yvg-1YIKGkEsZySLXmBeai0jkDFCmrADGNeWSlTqnHGIdCwBB8yKmZVzoVFLth9AgBuSsy13Y5rVFt1Rz4zY_hRqb1imeiYgnCU2lp6d_6KxprZ_MKUFlRoVMk8Sr805p2zhnsVQLa-Zg14pRtWlV-VbVd6venmwT23yOxa_8qdGDUQdWpsL1_0lqPH3sIr8Az--AtQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3069036877</pqid></control><display><type>article</type><title>Nurse‐led renal cell carcinoma clinic: a single center review</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Thia, I. ; Tan, A. ; Botha, E. ; Picardo, A. ; Brown, M. ; Thyer, I. ; Abdul‐Hamid, A. ; Tan, A. ; Teichmann, D. ; Hayne, D. ; McCombie, S.P.</creator><creatorcontrib>Thia, I. ; Tan, A. ; Botha, E. ; Picardo, A. ; Brown, M. ; Thyer, I. ; Abdul‐Hamid, A. ; Tan, A. ; Teichmann, D. ; Hayne, D. ; McCombie, S.P.</creatorcontrib><description>Background
In 2015 our centre introduced a nurse‐led renal cell cancer follow‐up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ‐confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow‐up processes.
Objectives
The primary objective was to assess the effectiveness of a nurse‐led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.
Patient and Methods
All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk‐stratification and theoretical outcomes between the protocols.
Results
After a mean follow up period of 31.2 months (range 0–77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi‐disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re‐stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x‐ray (CXR) in this cohort and our protocol tended to place patients in higher risk‐stratification groups as compared to current EAU guidelines.
Conclusion
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and CT should be considered the imaging modality of choice for this purpose.</description><identifier>ISSN: 1445-1433</identifier><identifier>ISSN: 1445-2197</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.18920</identifier><identifier>PMID: 38426382</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cancer ; Carcinoma, Renal Cell - pathology ; Computed tomography ; Female ; Follow-Up Studies ; Guideline Adherence ; Guidelines ; Humans ; Information systems ; Kidney cancer ; Kidney Neoplasms - diagnostic imaging ; Kidney Neoplasms - pathology ; Male ; Malignancy ; Medical imaging ; Middle Aged ; Neoplasm Recurrence, Local ; Nephrectomy ; Nephrectomy - methods ; nurse‐led clinics ; Patients ; Practice Patterns, Nurses ; Renal cell carcinoma ; Resource utilization ; Retrospective Studies ; Risk groups ; Surveillance ; Urology ; Western Australia</subject><ispartof>ANZ journal of surgery, 2024-06, Vol.94 (6), p.1071-1075</ispartof><rights>2024 Royal Australasian College of Surgeons.</rights><rights>2024 Royal Australasian College of Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3130-ab6646dbcebdc2343b1ae681da12c0261fcb02a5c53aa30bd50f5dc860c144ca3</cites><orcidid>0009-0002-9718-4178</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.18920$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.18920$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38426382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thia, I.</creatorcontrib><creatorcontrib>Tan, A.</creatorcontrib><creatorcontrib>Botha, E.</creatorcontrib><creatorcontrib>Picardo, A.</creatorcontrib><creatorcontrib>Brown, M.</creatorcontrib><creatorcontrib>Thyer, I.</creatorcontrib><creatorcontrib>Abdul‐Hamid, A.</creatorcontrib><creatorcontrib>Tan, A.</creatorcontrib><creatorcontrib>Teichmann, D.</creatorcontrib><creatorcontrib>Hayne, D.</creatorcontrib><creatorcontrib>McCombie, S.P.</creatorcontrib><title>Nurse‐led renal cell carcinoma clinic: a single center review</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>Background
In 2015 our centre introduced a nurse‐led renal cell cancer follow‐up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ‐confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow‐up processes.
Objectives
The primary objective was to assess the effectiveness of a nurse‐led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.
Patient and Methods
All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk‐stratification and theoretical outcomes between the protocols.
Results
After a mean follow up period of 31.2 months (range 0–77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi‐disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re‐stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x‐ray (CXR) in this cohort and our protocol tended to place patients in higher risk‐stratification groups as compared to current EAU guidelines.
Conclusion
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and CT should be considered the imaging modality of choice for this purpose.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Guideline Adherence</subject><subject>Guidelines</subject><subject>Humans</subject><subject>Information systems</subject><subject>Kidney cancer</subject><subject>Kidney Neoplasms - diagnostic imaging</subject><subject>Kidney Neoplasms - pathology</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Nephrectomy</subject><subject>Nephrectomy - methods</subject><subject>nurse‐led clinics</subject><subject>Patients</subject><subject>Practice Patterns, Nurses</subject><subject>Renal cell carcinoma</subject><subject>Resource utilization</subject><subject>Retrospective Studies</subject><subject>Risk groups</subject><subject>Surveillance</subject><subject>Urology</subject><subject>Western Australia</subject><issn>1445-1433</issn><issn>1445-2197</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10E1LwzAYB_AgipvTg19ACl700C0vbdp6kTF8A5kH9Ryepk8lo2tnsjp28yP4Gf0kZnZ6EMwhCeTHnzx_Qo4ZHTK_RlC7IUszTndIn0VRHHKWJbvbO4uE6JED52aUMimzeJ_0RBpxKVLeJ5fT1jr8fP-osAgs1lAFGiu_gdWmbuYQ6MrURl8EEDhTv1To3-slWo_fDK4OyV4JlcOj7Tkgz9dXT5Pb8P7h5m4yvg-1YIKGkEsZySLXmBeai0jkDFCmrADGNeWSlTqnHGIdCwBB8yKmZVzoVFLth9AgBuSsy13Y5rVFt1Rz4zY_hRqb1imeiYgnCU2lp6d_6KxprZ_MKUFlRoVMk8Sr805p2zhnsVQLa-Zg14pRtWlV-VbVd6venmwT23yOxa_8qdGDUQdWpsL1_0lqPH3sIr8Az--AtQ</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Thia, I.</creator><creator>Tan, A.</creator><creator>Botha, E.</creator><creator>Picardo, A.</creator><creator>Brown, M.</creator><creator>Thyer, I.</creator><creator>Abdul‐Hamid, A.</creator><creator>Tan, A.</creator><creator>Teichmann, D.</creator><creator>Hayne, D.</creator><creator>McCombie, S.P.</creator><general>John Wiley & Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0002-9718-4178</orcidid></search><sort><creationdate>202406</creationdate><title>Nurse‐led renal cell carcinoma clinic: a single center review</title><author>Thia, I. ; Tan, A. ; Botha, E. ; Picardo, A. ; Brown, M. ; Thyer, I. ; Abdul‐Hamid, A. ; Tan, A. ; Teichmann, D. ; Hayne, D. ; McCombie, S.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3130-ab6646dbcebdc2343b1ae681da12c0261fcb02a5c53aa30bd50f5dc860c144ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Computed tomography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Guideline Adherence</topic><topic>Guidelines</topic><topic>Humans</topic><topic>Information systems</topic><topic>Kidney cancer</topic><topic>Kidney Neoplasms - diagnostic imaging</topic><topic>Kidney Neoplasms - pathology</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local</topic><topic>Nephrectomy</topic><topic>Nephrectomy - methods</topic><topic>nurse‐led clinics</topic><topic>Patients</topic><topic>Practice Patterns, Nurses</topic><topic>Renal cell carcinoma</topic><topic>Resource utilization</topic><topic>Retrospective Studies</topic><topic>Risk groups</topic><topic>Surveillance</topic><topic>Urology</topic><topic>Western Australia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thia, I.</creatorcontrib><creatorcontrib>Tan, A.</creatorcontrib><creatorcontrib>Botha, E.</creatorcontrib><creatorcontrib>Picardo, A.</creatorcontrib><creatorcontrib>Brown, M.</creatorcontrib><creatorcontrib>Thyer, I.</creatorcontrib><creatorcontrib>Abdul‐Hamid, A.</creatorcontrib><creatorcontrib>Tan, A.</creatorcontrib><creatorcontrib>Teichmann, D.</creatorcontrib><creatorcontrib>Hayne, D.</creatorcontrib><creatorcontrib>McCombie, S.P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thia, I.</au><au>Tan, A.</au><au>Botha, E.</au><au>Picardo, A.</au><au>Brown, M.</au><au>Thyer, I.</au><au>Abdul‐Hamid, A.</au><au>Tan, A.</au><au>Teichmann, D.</au><au>Hayne, D.</au><au>McCombie, S.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nurse‐led renal cell carcinoma clinic: a single center review</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2024-06</date><risdate>2024</risdate><volume>94</volume><issue>6</issue><spage>1071</spage><epage>1075</epage><pages>1071-1075</pages><issn>1445-1433</issn><issn>1445-2197</issn><eissn>1445-2197</eissn><abstract>Background
In 2015 our centre introduced a nurse‐led renal cell cancer follow‐up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ‐confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow‐up processes.
Objectives
The primary objective was to assess the effectiveness of a nurse‐led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.
Patient and Methods
All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk‐stratification and theoretical outcomes between the protocols.
Results
After a mean follow up period of 31.2 months (range 0–77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi‐disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re‐stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x‐ray (CXR) in this cohort and our protocol tended to place patients in higher risk‐stratification groups as compared to current EAU guidelines.
Conclusion
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
Nurse‐led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and CT should be considered the imaging modality of choice for this purpose.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>38426382</pmid><doi>10.1111/ans.18920</doi><tpages>5</tpages><orcidid>https://orcid.org/0009-0002-9718-4178</orcidid></addata></record> |
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| ispartof | ANZ journal of surgery, 2024-06, Vol.94 (6), p.1071-1075 |
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| subjects | Adult Aged Aged, 80 and over Cancer Carcinoma, Renal Cell - pathology Computed tomography Female Follow-Up Studies Guideline Adherence Guidelines Humans Information systems Kidney cancer Kidney Neoplasms - diagnostic imaging Kidney Neoplasms - pathology Male Malignancy Medical imaging Middle Aged Neoplasm Recurrence, Local Nephrectomy Nephrectomy - methods nurse‐led clinics Patients Practice Patterns, Nurses Renal cell carcinoma Resource utilization Retrospective Studies Risk groups Surveillance Urology Western Australia |
| title | Nurse‐led renal cell carcinoma clinic: a single center review |
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