Developing a 21st century model of nurse-led follow-up after curative germ cell tumour treatment
Funder: NIHR Doctoral Research Fellowship (personal award holder: Gwen Saalmink)
Background: Due to improved treatments, more people are living after cancer. Cancer can relapse, and treatments also often cause long-term health problems, so follow-up after treatment is necessary. Follow-up can also identify needs in wider areas that cancer treatment clearly influences, such as family life, friendships, work, education etc. This is particularly so for germ cell tumours where more than 95% of patients are successfully treated.
Follow-up in specialist hospital clinics is burdensome on patients and NHS services. Waiting times are long and patients often have to travel long distances, meaning a lot of life disruption – missing time from work or education, having to arrange childcare – for what is an important but short assessment for most. This seems not to be meeting patients’ needs either as the care provided is mainly medical but missing important psychological needs. New models of follow-up should be much better.
Two UK hospitals have developed follow-up whereby tests and investigations are arranged flexibly in their community, using local and online (telemedicine) services. This is safe and effective. It allows test appointments to fit in with work/education/training and empowers patients to engage with their own care.
However, as telemedicine in germ cell cancer follow-up is new, we do not know yet what patients need from this model and whether nurses are best placed to deliver these services.
Overall aim: This project will inform clinical practice by creating guidance documents for nurse-led telemedicine follow-up after germ cell tumours, adjusted to patients’ needs, less burdensome on people and their lives, and reducing the strain on our NHS.
Methods: The project will be informed by the new framework for developing and evaluating complex interventions, consisting of 4 interconnected workstreams:
- Mixed method systematic review on efficacy, key components of cancer telemedicine, utilisation of PROMs within cancer telemedicine, models of change that apply to implementing telemedicine and the role nurses play in telemedicine models of follow-up (Progress: completed, currently in write up for publication).
- Qualitative analysis of patients’ needs of follow-up (Progress: analysis stage)
- Developing consensus and training needs analysis on key components of nurse-led telemedicine follow-up (Progress: Delphi live. Focus groups aim to start in November 2026).
- Finalisation of the toolkit through a stakeholder workshop, to design future implementation studies of telemedicine in GCT follow-up (Progress: to be delivered in 2027).
Study team: This project is led by Gwen Saalmink (University of Leeds/Leeds Teaching Hospitals NHS Trust), and supervised by Prof Dan Stark (University of Leeds), Dr Kate Absolom (University of Leeds), Dr Sue Hartup (Leeds Teaching Hospitals NHS Trust), Prof Lynn Calman (University of Southampton) and Dr Lisa McCann (University of Strathclyde).
Publications:
Saalmink, G., Patel, F., Hartup, S. et al. Evaluation of telemedicine intervention implementation during cancer follow-up: a mixed methods systematic review protocol. Syst Rev (2026). https://doi.org/10.1186/s13643-026-03302-x