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Implementation and Evaluation of a Risk-Stratified Nurse-Led Thyroid Cancer Follow-Up Clinic: A Single-Centre Retrospective Service Evaluation.

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Cureus 2026 Vol.18(3) p. e105098
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Kaimal KM

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[BACKGROUND]  Post-treatment surveillance for differentiated thyroid cancer (DTC) can extend for many years, contributing to increasing outpatient follow-up workload.

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APA Kaimal KM (2026). Implementation and Evaluation of a Risk-Stratified Nurse-Led Thyroid Cancer Follow-Up Clinic: A Single-Centre Retrospective Service Evaluation.. Cureus, 18(3), e105098. https://doi.org/10.7759/cureus.105098
MLA Kaimal KM. "Implementation and Evaluation of a Risk-Stratified Nurse-Led Thyroid Cancer Follow-Up Clinic: A Single-Centre Retrospective Service Evaluation.." Cureus, vol. 18, no. 3, 2026, pp. e105098.
PMID 41994666

Abstract

[BACKGROUND]  Post-treatment surveillance for differentiated thyroid cancer (DTC) can extend for many years, contributing to increasing outpatient follow-up workload. Risk-stratified models that delegate selected low-risk follow-up to nurse-led clinics may improve sustainability if delivered within a robust governance framework.

[METHODS]  We undertook a single-centre retrospective service evaluation in a UK district general hospital to assess the implementation and safety of a nurse-led, risk-stratified thyroid cancer follow-up pathway. The evaluation period was July 14, 2020, to February 13, 2026. Sixty eligible low-risk DTC patients were analysed as a random sample: 30 follow-up encounters managed in a consultant-led clinic and 30 managed in a nurse-led clinic. A structured follow-up proforma standardised documentation of red flag symptom screening, wound assessment, voice assessment, and biochemical review (including calcium/parathyroid hormone where clinically indicated), and defined escalation criteria to consultant review.

[RESULTS]  In the nurse-led cohort, one patient required escalation for assessment of a submandibular swelling, with subsequent review confirming reactive lymphadenitis and return to the nurse-led pathway. The escalation proportion was 3.3% with a 95% confidence interval (CI) of 0.6%-16.7%. No missed malignancies, unplanned readmissions, or safety incidents were identified during the evaluation. Protocol compliance across safety domains in the nurse-led cohort was 100%.

[CONCLUSION]  A governance-supported nurse-led thyroid cancer follow-up clinic for appropriately selected low-risk DTC patients can be delivered safely, with high protocol compliance and low escalation rates, supporting sustainable outpatient service redesign.