Case management to increase quality of life after cancer treatment: a randomized controlled trial

Abstract

Background: Case management has been shown to be beneficial in phases of cancer screening and treatment. After treatment is completed, patients experience a loss of support due to reduced contact with medical professionals. Case management has the potential to offer continuity of care and ease re-entry to normal life. We therefore aim to investigate the effect of case management on quality of life in early cancer survivors.

Methods: Between 06/2010 and 07/2012, we randomized 95 patients who had just completed cancer treatment in 11 cancer centres in the canton of Zurich, Switzerland. Patients in the case management group met with a case manager at least three times over 12 months. Patient-reported outcomes were assessed after 3, 6 and 12 months using the Functional Assessment of Cancer Therapy (FACT-G) scale, the Patient Assessment of Chronic Illness Care (PACIC) and the Self-Efficacy scale.

Results: The change in FACT-G over 12 months was significantly greater in the case management group than in the control group (16.2 (SE 2.0) vs. 9.2 (SE 1.5) points, P = 0.006). The PACIC score increased by 0.20 (SE 0.14) in the case management group and decreased by 0.29 (SE 0.12) points in the control group (P = 0.009). Self-Efficacy increased by 3.1 points (SE 0.9) in the case management group and by 0.7 (SE 0.8) points in the control group (P = 0.049).

Conclusions: Case management has the potential to improve quality of life, to ease re-entry to normal life and to address needs for continuity of care in early cancer survivors.

Trial registration: The study has been submitted to the ISRCTN register under the name "Case Management in Oncology Rehabilitation" on the 12th of October 2010 and retrospectively registered under the number ISRCTN41474586 on the 24th of November 2010.

Keywords: Cancer; Self-Efficacy; case management; health behaviour; quality of life; self care; survivors.

Fig. 1

CONSORT Flow-Chart

Fig. 2

Crude FACT-G scale mean over time. The repeated measure mixed model regression analysis showed a significant trend for time overall (P < 0.001) and a significant trend for time* group (P = 0.002)

Fig. 3

Crude Self-Efficacy mean over time. The repeated measure mixed model regression analysis showed a significant trend for time overall (P < 0.001) and for time*group (P = 0.002)

Fig. 4

Crude PACIC scale mean over time. The repeated measure mixed model regression analysis in the UC group showed a negative trend for time (P = 0.005)