Palliative care for patients with irresectable or recurrent cancer of the upper gastrointestinal tract: a randomized study.

For patients with irresectabel of recurrent esophageal-, pancreatic- or
hepatobiliary cancer, no curative treatment options are available. The median survival for this group is only 2-10 months. The treatment aim in the palliative phase is to improve the quality of life of patients and
their family, through the prevention and relief of suffering by means of the identification and treatment of pain and other physical, psychosocial and spiritual problems. The high degree of physical and psychological problems in this phase suggest a need for close monitoring and support.
Presently, patients in the palliative phase of their disease visit the outpatient clinic for medical follow up. The frequency is usually low with a mean of every 8 weeks. These visits to the hospital are a burden for the majority of patients. We hypothesized that nurse-led follow up at home could be a valuable alternative for these patients. This study will evaluate nurse-led follow up for palliative GI cancer patients by home visits. Outcome will be compared with the usual medical follow up at the outpatient clinic. Outcome measures are: quality of life, patient satisfaction and costs.

Does nurse-led follow up at home lead to improved quality of life an satifaction and a reduction of costs compared to medical follow up at the outpatient clinic, without compromising the medical condition of patients?

Nurse led follow up at home at 2-weekly and later monthly intervals until month 13 or death versus medical follow up at the outpatient clinic at 1 month and thereafter every 2 months until month 13 or death.