A PILOT-STUDY EXPLORING THE EFFECT OF DISCHARGING CANCER SURVIVORS FROM HOSPITAL FOLLOW-UP ON THE WORKLOAD OF GENERAL-PRACTITIONERS

Background. The tradition of routine, long-term follow-up of cancer pa tients in the outpatient clinic has led to busy clinics and long waiti ng times. Many cancer patients are anxious and have become dependent o n the specialist clinic for reassurance. General practitioners (GPs) h ave been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonst rated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased d emand on GP practices. Aim. To determine the consequences for GPs of d ischarging long-term cancer patients from a hospital outpatient follow -up clinic. Method. A consecutive sample of 65 patients under annual r eview in a hospital oncology clinic were offered a planned discharge i n which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depress ion rates were assessed using the Hospital Anxiety and Depression Scal e (HADS) at the time of discharge and four months later at a home inte rview. The GPs of all patients who were discharged were sent questionn aires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity. Results. The results show ed no significant increase in the consultation rates during the 12 mon ths after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depre ssion. GPs thought there was a need for more specialist Macmillan nurs es working in the community and highlighted the importance of fast-tra ck specialist referral. Conclusion. Discharging this group of long-ter m cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the comm unity suggests that primary care services may find it difficult to cop e adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training require ments of GPs in the routine follow-up of cancer patients.