Nurse-Led Care Coordination After Colorectal Cancer Surgery Failed to Show Effect

The use of a centralized nurse-led telephone-based care coordination system failed to improve outcomes including quality of life, unmet supportive needs, or visits to the emergency department after surgical resection of colorectal cancer, according to the results of a study published in the Journal of Clinical Oncology.

According to the researchers, this failure may indicate that future studies to improve outcomes in these patients may need to focus on a more tailored approach.

“There is an internationally recognized need to develop better models of service delivery and care coordination to improve the quality of cancer care,” the researchers wrote. “One such model that has had success for women with early breast cancer involves the use of cancer nurse care coordinators as key contacts for patients, providing specialist support and single points of contact to coordinate care.”

In this study, the researchers examined a nurse-led care coordination model for patients with colorectal cancer, whose disease treatment frequently includes multimodality treatment such as surgery, radiation, and/or chemotherapy.

The CONNECT intervention consisted of five scheduled, structured follow-up phone calls on days 3 and 10, and then at month 1, 3, and 6 after hospital discharge. During each call, nurses asked 22 questions to find out about common problems including physical, psychological, supportive care, and informational needs. Any needs identified were addressed using standardized protocols. For any high-risk problems, the nurse contacted a member of the patient’s health care team directly.

The researchers enrolled 775 patients treated at 23 public and private hospitals in Australia and randomly assigned them to the intervention (n = 387) or to a control group (n = 369).

Results indicated that levels of unmet supportive care needs were low in both groups at 3 and 6 months. In addition, patients assigned the intervention had similar decreases in levels of distress as those assigned to the control group.

Emergency department presentation occurred in 10.8% of patients assigned the intervention and 13.8% assigned to control, a non-significant difference; there was also no significant difference in the number of unplanned hospital readmissions.

The researchers also examined patient opinion of the intervention used in the study.

“For patients whose local health care team was available to provide information and support, CONNECT was perceived to play no real part in their postoperative recovery,” the researchers wrote. “A second group of patients felt they did not require CONNECT, because their recovery was straightforward and uneventful. A third group of patients who did have acute concerns, such as wound-related issues, bowel function, and symptom management, perceived CONNECT as an important service that assisted them in their postoperative recovery.”

Based on the results of this study, the researchers did not recommend that this intervention by broadly implemented.