2023-06-08 21:08:45
Follow-up of patients who have completed treatment for their colorectal cancer (CRC) is carried out by oncologists, but this follow-up is expensive and sometimes difficult to ensure given the medical time required and the active queue of patients. Would it be possible to consider shared follow-up between the oncologist and the general practitioner according to a formalized protocol, like what is traditionally envisaged in chronic diseases such as diabetes, asthma or heart disease?
In order to assess the acceptability of this shared care approach and its modalities, an Australian team from Melbourne (Australia) conducted a randomized multicentre study, the results of which were presented by Pr Michel Jefford (Peter McCallum Cancer Centre, Melbourne ) as part of the ASCO congress (American Society of Clinical Oncology, June 2-6, 2023, Chicago, USA).
This study, named SCORE (Shared care of Colorectal cancer survivors) recruited patients with and treated for stage I to III CRC, who had just completed their care within the previous three months. Those who agreed to participate, and whose general practitioner also accepted, were randomized between a traditional follow-up (1 visit to the oncologist at 3, 6, 9 and 12 months with clinical examination and dosage of the ACE antigen, a scanner if necessary at 12 months) or shared follow-up (same protocol in which 1 additional visit was added by the general practitioner at 2-6 weeks following the end of treatment and where the visits at 3 and 9 months were carried out by the latter). Patients received information on the protocol to follow and on the disease. GPs received a copy of the care plan, recommendations for the management of post-treatment CRC patients, common problems encountered, and hospital contacts to be reached in case of need for advice or suspicion of recurrence.
Satisfaction and a comparable prognosis at 12 months
The course, disrupted by the COVID-19 pandemic, required an adjustment of its protocol as well as the evaluation criteria. The main objective was to ensure the non-inferiority of this shared care protocol compared to the standard protocol provided by the oncologist, in particular according to the general quality of life (GHQ-QOL score) over the 12 months or the specific quality of life related to CRC (EORTC QQLQ-C30 score). The criteria of satisfaction, perception of care, preference and unmet needs were assessed with the patients using specific questionnaires.
And this study, which brought together 150 patients, confirms the non-inferiority in terms of quality of life and the lower costs associated with patient follow-up via the protocol integrating the attending physician, compared to the course provided by the oncologist. “It should be noted that the patients and the doctors were quite willing to participate and that the retention rates remained high during the study” insisted the speaker. The authors also observed no difference in patient satisfaction. They were also more likely to favor the interest of a shared approach, rather than just a specialized one in the two groups of the study, which suggests that even the patients who had not benefited from the shared follow-up were more willing interested in follow-up involving their GP. Finally, it should be noted that the disease recurrence rate and time were comparable in the two groups, with use of the comparable CEA assay. ” These data suggest the feasibility of following up CRC patients following the end of their treatment as we have previously described in the case of prostate cancer.concluded Professor Michel Jefford. This shared care model might be appropriate for other tumor pathologies ».
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