Intended for healthcare professionals


Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial

BMJ 2009; 338 doi: (Published 15 January 2009) Cite this as: BMJ 2009;338:a3147
  1. Kinta Beaver, professor of nursing1,
  2. Debbie Tysver-Robinson, nurse consultant2,
  3. Malcolm Campbell, lecturer in statistics1,
  4. Mary Twomey, research associate1,
  5. Susan Williamson, research fellow1,
  6. Andrew Hindley, consultant clinical oncologist3,
  7. Shabbir Susnerwala, consultant clinical oncologist3,
  8. Graham Dunn, professor of biomedical statistics4,
  9. Karen Luker, professor of nursing1
  1. 1School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL
  2. 2Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust, Blackpool, Lancashire
  3. 3Rosemere Cancer Centre, Royal Preston Hospital, Preston, Lancashire
  4. 4Health Methodology Research Group, University of Manchester, Manchester
  1. Correspondence to: K Beaver kinta.beaver{at}
  • Accepted 15 October 2008


Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer.

Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months.

Setting Outpatient clinics in two NHS hospital trusts in the north west of England

Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence.

Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy).

Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease.

Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228).

Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics.

Trial registration National Cancer Research Institute 1477.


  • We thank the following collaborators whose continued support was vital to the successful completion of the study: A Baildam, L Barr, G Byrne, V Chadwick, F Danwata, S Foster, P Kiriparan, M Noblet, F O’Regan, S Rajan, L Thomson, C Turner. Lesley Degner’s seminal work on information needs of cancer patients has provided continued inspiration. We also thank all the patients who participated in this study.

  • Contributors: KB was principal investigator and together with MC, GD, AH. KL, SS, MT, and DTR contributed to the study concept and design. KB, MT, and SW took main responsibility for the acquisition of data; MC and GD were responsible for data analysis and all authors were responsible for interpretation of findings. KB, MC, and KL drafted the manuscript and all authors contributed to the critical revision of the manuscript. KB, GD, AH, KL, and SS obtained funding. KB is the guarantor.

  • Funding: The trial was funded by the Medical Research Council (UK) and a project grant from Rosemere Cancer Foundation (UK). The funding agencies had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the central office of research ethics committees in England and research and development departments at both study sites. All participants gave both verbal and written consent to take part in the study.

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

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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