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Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation
  1. Iqra Luqman1,
  2. Rochelle Wickham-Joseph1,
  3. Nicola Cooper2,
  4. Louise Boulter1,
  5. Nafisa Patel1,
  6. Priyanga Kumarakulasingam1 and
  7. Esther L Moss1,3
  1. 1 Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2 Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3 Leicester Cancer Research Centre, University of Leicester, Leicester, UK
  1. Correspondence to Dr Esther L Moss, Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK; em321{at}


Objective Risk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up.

Methods Women diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. The time/distance traveled by patients from their home address to the hospital clinic was calculated and used to determine patient-related costs.

Results A total of 187 patients with a median of 37 (range 2–62) months follow-up after primary surgery were enrolled on the scheme. In total, the cohort were scheduled to attend 1673 appointments with hospital follow-up, whereas they only attended 69 clinic appointments and made 107 telephone contacts with patient-initiated follow-up. There was a 93.5% reduction in costs from a projected £194 068.00 for hospital follow-up to £12 676.33 for patient-initiated follow-up. The mean patient-related costs were reduced by 95.6% with patient-initiated follow-up. The total mileage traveled by patients for hospital follow-up was 30 891.4 miles, which was associated with a mean traveling time per patient of 7.41 hours and clinic/waiting time of 7.5 hours compared with 1165.8 miles and 0.46 hours and 0.5 hours, respectively, for patient-initiated follow-up.

Conclusion The introduction of a patient self-management follow-up scheme for low-risk endometrial cancer was associated with financial/time saving to both the patient and the healthcare economy as compared with hospital follow-up.

  • Endometrial Neoplasms
  • Postoperative Period

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  • Contributors EM, LB, and NP conceived the idea for the study. IQ, PK, and RW-J performed the data collection. NP performed the analysis. EM wrote the manuscript and all the authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ELM has been awarded research grants from Cancer Research UK, Hope Against Cancer, and Intuitive Surgical Ltd for projects unrelated to this work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request