General Practitioner–Led Survivorship Care Can Be Considered an Alternative to Surgeon-Led Care Within the First Year of Colon Cancer Treatment

Survivorship care led by general practitioners can be an alternate to surgeon-led survivorship care for patients with colon cancer who are within their first year treatment, according to the1-year results of an interim analysis of 1-year results from a trial published in Lancet Oncology.

After a median follow up of 12.2 months, improvements in quality of life and decreases in symptom burden were reported to be high among those receiving general practitioner–led and surgeon-led care. In addition to utilizing general practitioner– and surgeon-led care, an e-Health app called Oncokompas was utilized to evaluate quality of life (QoL) in the 2 cohorts of patients. There was no clinically meaningful difference in QoL at 12 months between the 2 groups (-2.3; (95% CI, -5.0 to 0.4), nor were there any differences between those who utilized Oncokompas and those who did not utilize Oncokompas (-0.1; 95% CI, -2.8 to 2.6).

“In this study, we assessed whether the QOL of patients with colon cancer during the first year after treatment with curative intent was affected by whether survivorship care was managed by their surgeon or their GP (general practitioner). Overall, the study population showed high levels of QOL at baseline compared with reference data. Within the first year of follow-up, there were no meaningful differences in change in QOL from baseline between GP-led and surgeon-led care. We also noted no differences in changes in QOL between patients who were allocated to Oncokompas and those who were not, suggesting that Oncokompas had no beneficial effects in this trial,” the investigators of the study said.

The randomized, controlled study included 303 patients. Of these patients, 141 received general practitioner–led care, 68 of whom had access to Oncokompas, and 162 patients received surgeon-led care, 83 of whom have access to Oncokompas. A total of 250 general practitioners participated in the study with 126 being allocated to provide survivorship care. Within the first year, 18% (n = 25) of patients transferred from general practitioners to surgeon-led care.

Patients continued to fill out questionnaires during the follow-up year. At the request of 6 patients in the general practitioner group, and 4 in the surgeon-led group, questionnaires were suspended. Additionally, 9 patients did not complete the initial questionnaire and 4 patients did not complete the subsequent questionnaires. Additionally, during that first year, no patients were lost to follow-up.

Of the 151 patients assigned to use Oncokompas, 92% (n = 142) had an email and access to the internet, 36% ( n = 51) used the application at least once, and 17% (n = 24) patients used the application more than once. When investigators performed a post-hoc analysis, they identified that those who used Oncokompas at least once had a higher educational attainment vs those who did not use it at least once (P = .044). 

The baseline QLQ-C30 scores at baseline for the general practitioner group was 90.2 (Standard deviation [SD], 9.1) and the surgeon-led group was 86.1 (SD, 11.0). Patients in the general practitioner groups had slightly better quality of life scores at baseline in almost all domaine (mean, 88.4; SD 19.3) than in the surgeon-led group (78.2; SD 26.5), with a clinically meaningful difference in the role functioning subdomain, which related to assessing a patient’s ability to complete daily activities.

Additional findings from the study indicated that 68 patients who had received adjuvant chemotherapy were not considered for inclusion until their treatment was complete. Notably, the group provided little data for the first year following surgery. While the estimates were different from those who did not receive chemotherapy, they were not significant. There were no significant changes found in quality of life from baseline to 1-year among those who used Oncokompas and those who did not (-0.1; 95% CI -2.8-2.6.

“Improved understanding of QoL provides insights into the effects of treatment and the optimal organization of survivorship care, and it also shows prognostic value for overall survival,” the investigators concluded.

Reference:

Vos JAM, Duineveld LAM, Wieldraaijer T, et al. Effect of general practitioner-led versus surgeon-led colon cancer survivorship care, with or without eHealth support, on quality of life (I CARE): an interim analysis of 1-year results of a randomised, controlled trial. Lancet Oncol. 2021;22(8):1175-1187. doi:10.1016/S1470-2045(21)00273-4