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The ENHANCES study: a randomised controlled trial of a nurse-led survivorship intervention for patients treated for head and neck cancer

  • Jane TurnerEmail author
  • Patsy Yates
  • Lizbeth Kenny
  • Louisa G Gordon
  • Bryan Burmeister
  • Brett G M Hughes
  • Alexandra L McCarthy
  • Chris Perry
  • Raymond J Chan
  • Alana Paviour
  • Helen Skerman
  • Martin Batstone
  • Lisa Mackenzie
Original Article

Abstract

Purpose

A randomised controlled trial was conducted to evaluate the effectiveness of a nurse-delivered Head and Neck Cancer Survivor Self-Management Care Plan (HNCP) for patients who had completed treatment for head and neck cancer (HNC).

Methods

Ten oncology nurses were trained to deliver the HNCP. The HNCP consisted of one face-to-face hour-long meeting in which the patient’s treatment was recorded, as were contact details of health professionals involved in their care and follow-up schedules. Patients were guided to nominate up to three goals for their future well-being and assisted to devise an action plan to achieve these. The HNCP was given to the patient and a copy was forwarded to their primary care physician. One hundred and nine patients were randomised after definitive curative intent treatment, 36 to HNCP, 36 to receive information about survivorship, and 37 to usual care. The primary outcome, analysed by intention-to-treat, was change in quality of life measured by the FACT-H&N from baseline to 6-month follow-up.

Results

Quality of life of all groups decreased at 3 months but was close to baseline at 6 months. Compared with the usual care group, the only statistically significant mean difference at 6 months was for the information group on the physical well-being domain (mean difference 0.4, 95% − 1.8, 2.6, p < 0.05).

Conclusions

A single-session nurse-delivered intervention is insufficient to improve the quality of life in HNC survivors compared with usual care. Provision of detailed written information about HNC survivorship is associated with improved physical well-being.

Trial registration

ACTRN12613000542796

Keywords

Head and neck cancer Survivorship Self-management 

Notes

Acknowledgements

We thank the participating oncology nurses at Princess Alexandra Hospital and Royal Brisbane and Women’s Hospital. Dr Damien Thomson reviewed the original grant application. We thank Ms Fiona Caristo for her role as a research assistant, and Dr Sandro Porceddu and Ms Leanne Stone at PAH and Ms Helen McDade and Mr John Verbeeten at RBWH.

Funding information

This study was financially supported by the National Health and Medical Research Council (study ID: 1041640).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of each institution and the respective Universities and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclaimer

The funding body had no role in the study design, collection, analysis or interpretation of data, or writing of report, or decision to submit for publication. The authors have no financial relationship with the funding source. The authors have full control of all primary data and agree to allow the journal to review data if requested.

References

  1. 1.
    Hashim D, Boffetta P, La Vecchia C, Rota M, Bertuccio P, Malvezzi M, Negri E (2016) The global decrease in cancer mortality: trends and disparities. Ann Oncol 27:926–933.  https://doi.org/10.1093/annonc/mdw027 CrossRefGoogle Scholar
  2. 2.
    Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, Edwards BK (2013) Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancer and HPV vaccination coverage levels. J Natl Cancer I 105:175–201CrossRefGoogle Scholar
  3. 3.
    Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C (2015) Epidemiology of human-papillomavirus-positive head and neck squamous cell carcinoma. J Clin Oncol 33:3235–3242CrossRefGoogle Scholar
  4. 4.
    So WKW, Chan RJ, Chan DNS, Hughes BGM, Chair SY, Choi KC, Chan CWH (2012) Quality of life among head and neck cancer survivors at one year after treatment—a systematic review. Eur J Cancer 48:2391–2408CrossRefGoogle Scholar
  5. 5.
    Chauker DA, Walvekar RR, Das AK, Deshpande MS, Prathamesh SP, Chaturvedi P, Kakade A, d’Cruz AK (2009) Quality of life in head and neck cancer survivors: a cross-sectional survey. Am J Otolaryngol 30:176–180CrossRefGoogle Scholar
  6. 6.
    Hewitt M, Greenfield S, Stovall E (eds) (2006) From cancer patient to cancer survivor: lost in transition. The National Academies Press, WashingtonGoogle Scholar
  7. 7.
    Nekhlyudov L, Lacchetti C, Davis NB, Garvey TQ, Goldstein DP, Nunnink JC, Ninfea R, Salner AL, Salz T, Sui LL (2017) Head and neck cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline. J Clin Oncol 35:1606–1621CrossRefGoogle Scholar
  8. 8.
    Turner J, Yates P, Kenny L, Gordon LG, Burmeister B, Thomson D, Hughes B, McCarthy AL, Perry C, Chan RJ, Fraser A, Skerman H, Batstone M (2014) The ENHANCES study—enhancing head and neck cancer patients’ experiences of survivorship: study protocol for a randomized controlled trial. Trials 15:91CrossRefGoogle Scholar
  9. 9.
    Wagner EH, Austin BT, Von Korff M (1996) Improving outcomes in chronic illness. Manag Care Q 4:12–25Google Scholar
  10. 10.
    Gao WJ, Yuan CR (2011) Self-management programme for cancer patients: a literature review. Int Nurs Rev 58:288–295CrossRefGoogle Scholar
  11. 11.
    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioural change. Psychol Rev 84:191–215CrossRefGoogle Scholar
  12. 12.
    D’Antonio LL, Zimmerman GJ, Cella DF, Long SA (1996) Quality of life and functional status measures in patients with head and neck cancer. Arch Otolaryngol 122:482–487CrossRefGoogle Scholar
  13. 13.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Slieverman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579CrossRefGoogle Scholar
  14. 14.
    List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck (FACT-H&N) scale: a study of utility and validity. Cancer 77:2294–2301CrossRefGoogle Scholar
  15. 15.
    Cella D, Paul D, Yount S, Winn R, Chang C-H, Banik D, Weeks J (2003) What are the most important symptom targets when treating advanced cancer? A survey of providers in the National Comprehensive Cancer Network (NCCN). Cancer Investig 21:526–535CrossRefGoogle Scholar
  16. 16.
    Yount S, List M, Du H, Yost K, Bode R, Brockstein B, Argiris A, Vokes E, Cohen EEW, Campbell B, Valenzuela V, George J, Egan R, Chen J, Meddis D, Cella D (2007) A randomized validation study comparing embedded versus extracted FACT head and neck symptom index scores. Qual Life Res 6:1615–1626CrossRefGoogle Scholar
  17. 17.
    Merluzzi TV, Nairn RC, Hegde K, Sanchez MAM, Dunn L (2001) Self-efficacy for coping with cancer: revision of the cancer behaviour inventory (v 2). Psycho-Oncol 10:206–217CrossRefGoogle Scholar
  18. 18.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:362–370CrossRefGoogle Scholar
  19. 19.
    Singer S, Kunht S, Hauss J, Hinz A, Liebmann A, Krauss O, Lehmann A, Schwars R (2009) Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 100:908–912CrossRefGoogle Scholar
  20. 20.
    EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  21. 21.
    Ringash J, Beziak O, O’Sullivan B, Redelmeier DA (2004) Interpreting differences in quality of life: the FACT-H&N in laryngeal cancer patients. Qual Life Res 13:725–733CrossRefGoogle Scholar
  22. 22.
    Clinical Oncology Society of Australia Model of Survivorship Care Working Group (2016) Model of survivorship care: critical components of cancer survivorship care in Australia position statement. Clin Oncol Soc Aust https://www.cosa.org.au/media/332340/cosa-model-of-survivorship-care-full-version-final-20161107.pdf (Accessed 18.9.2018)
  23. 23.
    Van der Meulen IC, May AM, de Leeuw JRJ, Koole R, Oosteram M, Hordijk G-J, Ros WJG (2014) Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial. Brit J Cancer 110:593–601CrossRefGoogle Scholar
  24. 24.
    De Leeuw J, Prins JB, Teerenstra S, Merkz MAW, Marres HAM, van Achterbert T (2013) Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial. Support Care Cancer 21:537–547CrossRefGoogle Scholar
  25. 25.
    Campbell BH, Massey BL, Myers KBA (2012) Survivorship care plans for patients with head and neck cancer. Arch Otolaryngol 138:1116–1119CrossRefGoogle Scholar
  26. 26.
    Fingeret MC, Yan Y, Urbauer D, Weston J, Nipomnick S, Weber R (2012) The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psycho-Oncol 21:836–844CrossRefGoogle Scholar
  27. 27.
    Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, Rowland JH (2018) Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery. J Clin Oncol 36:2088–2100CrossRefGoogle Scholar
  28. 28.
    De Rooij BH, Ezebdan NPM, Nicolaije KAH, Lodder P, Vos MC, Pignenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV (2018) Survivorship care plans have a negative impact of long-term quality of life and anxiety through more threatening illness perceptions in gynecological cancer patients: the ROGY care trial. Qual Life Res 27:1533–1544CrossRefGoogle Scholar
  29. 29.
    Emory J (2014) Cancer survivorship—the role of the GP. Aust Fam Physician 43:521–525Google Scholar
  30. 30.
    Chan R, Downer TR (2018) Cancer nurses can bridge the gap between specialist cancer care and primary care settings to facilitate shared-care models. Cancer Nurs 42:89–90CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jane Turner
    • 1
    • 2
    Email author
  • Patsy Yates
    • 3
  • Lizbeth Kenny
    • 1
    • 2
  • Louisa G Gordon
    • 4
  • Bryan Burmeister
    • 5
  • Brett G M Hughes
    • 1
    • 2
  • Alexandra L McCarthy
    • 6
    • 7
  • Chris Perry
    • 6
  • Raymond J Chan
    • 3
    • 6
  • Alana Paviour
    • 2
  • Helen Skerman
    • 3
  • Martin Batstone
    • 1
    • 2
  • Lisa Mackenzie
    • 1
  1. 1.Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Royal Brisbane and Women’s HospitalBrisbaneAustralia
  3. 3.Queensland University of TechnologyBrisbaneAustralia
  4. 4.QIMR Berghofer Medical Research InstituteBrisbaneAustralia
  5. 5.GenesisCareFraser CoastAustralia
  6. 6.Princess Alexandra HospitalBrisbaneAustralia
  7. 7.School of NursingUniversity of AucklandAucklandNew Zealand

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