Rapid Fire Presentations 2025 National Cancer Survivorship Conference

Implementing a nurse-enabled, integrated, shared-care model involving specialists and general practitioners in breast cancer post-treatment follow-up (EMINENT): a single-centre, open-label, phase 2, parallel-group, pilot, randomised, controlled trial (#25)

Raymond Chan 1 2 3 , Fiona Crawford-Williams 1 , Chad Han 1 , Lee Jones 1 4 , Alexandre Chan 5 , Dan McKavanagh 3 , Marissa Ryan 3 , Christine Carrington 6 , Rebecca Packer 6 , Megan Crichton 2 , Nicolas Hart 1 2 7 8 9 , Emma McKinnell 3 , Melissa Gosper 3 , Juanita Ryan 3 , Bethany Crowe 1 3 , Ria Joseph 1 , Carolyn Ee 1 , Jane Lee 1 , Steven McPhail 2 , Katharine Cuff 3 , Laisa Teleni 2 , Jon Emery 10 11
  1. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  2. Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  3. Princess Alexandra Hospital, Metro south Health, Brisbane, Queensland, Australia
  4. QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
  5. Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, U.S.A.
  6. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  7. Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney, Sydney, New South Wales, Australia
  8. Exercise Medicine Research Institute, School of Medicine and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
  9. Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  10. Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia
  11. Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia

Aim: Current models of cancer survivorship follow-up care rely heavily on hospital-based, treating medical specialists which is unsustainable and insufficient to meet increasing demand. To evaluate the feasibility and preliminary effectiveness of implementing a nurse-enabled, shared-care follow-up model of care between acute and primary care for early breast cancer (EMINENT intervention).

Methods: A phase II pilot randomised controlled trial was conducted at a single tertiary cancer centre in Brisbane, Australia. Individuals diagnosed with breast cancer (Stage 0-III) were randomised to usual care or the EMINENT intervention which includes 1) Specialist Nurse consultation , 2) Pharmacist Consultation, 3) Case Conference with general practice, and 4) Shared follow-up care. Feasibility and effectiveness outcome measures, including health-related quality of life, physical activity and nutrition, patient experience, and financial toxicity were collected at baseline, and 3-, 6-, and 12-months, with health service utilisation data at 24-months. Bivariate and multivariable analyses were conducted using intention-to-treat principles.

Results: Sixty-one females were randomised (intervention n=29; usual care n=32); mean age  62.9 ±10.9 years. The EMINENT intervention was feasible with high completion rates (100%) across all elements of the specialist nurse survivorship consultation and GP case conference. Evaluation of the 29 survivorship care plans (SCPs; intervention arm) indicated the top three goals were exercise (n=23), diet (n=12) and mental well-being (n=11) and could be managed by primary care. No differences were observed between groups for a range of primary and secondary outcomes. There were significantly fewer post-treatment radiation oncology appointments in the intervention group compared to the control group (P=0·03) at 24-months. Number of unplanned hospital presentations at 24-months were low across both intervention (n=7) and control (n=4) groups.

Conclusion: Nurse-enabled, shared-care arrangements for women with early breast cancer is feasible and warrants continuation to large, hybrid effectiveness-implementation trial.