Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 May 8;115(5):523-529.
doi: 10.1093/jnci/djad019.

Detection of colon cancer recurrences during follow-up care by general practitioners vs surgeons

Julien A M Vos  1   2 , Edanur Sert  1 , Wim B Busschers  1 , Laura A M Duineveld  1 , Thijs Wieldraaijer  1 , Jan Wind  1 , Sandra C Donkervoort  3 , Marc J P M Govaert  4 , Frédérique H Beverdam  5 , Anke B Smits  6 , Willem A Bemelman  7 , Gijsbert Heuff  8 , Henk C P M van Weert  1   2 , Kristel M van Asselt  1   2 ; I CARE study Group
Collaborators, Affiliations
Randomized Controlled Trial

Detection of colon cancer recurrences during follow-up care by general practitioners vs surgeons

Julien A M Vos et al. J Natl Cancer Inst. .

Abstract

Background: In the I CARE study, colon cancer patients were randomly assigned to receive follow-up care from either a general practitioner (GP) or a surgeon. Here, we address a secondary outcome, namely, detection of recurrences and effect on time to detection of transferring care from surgeon to GP.

Methods: Pattern, stage, and treatment of recurrences were described after 3 years. Time to event was defined as date of surgery, until date of recurrence or last follow-up, with death as competing event. Effects on time to recurrence and death were estimated as hazard ratios (HRs) using Cox regression. Restricted mean survival times were estimated.

Results: Of 303 patients, 141 were randomly assigned to the GP and 162 to the surgeon. Patients were male (67%) with a mean age of 68.0 (8.4) years. During follow-up, 46 recurrences were detected; 18 (13%) in the GP vs 28 (17%) in the surgeon group. Most recurrences were detected via abnormal follow-up tests (74%) and treated with curative intent (59%). Hazard ratio for recurrence was 0.75 (95% confidence interval [CI] = 0.41 to 1.36) in GP vs surgeon group. Patients in the GP group remained in the disease-free state slightly longer (2.76 vs 2.71 years). Of the patients, 38 died during follow-up; 15 (11%) in the GP vs 23 (14%) in the surgeon group. Of these, 21 (55%) deaths were related to colon cancer. There were no differences in overall deaths between the groups (HR = 0.76, 95% CI = 0.39 to 1.46).

Conclusion: Follow-up provided by GPs vs surgeons leads to similar detection of recurrences. Also, no differences in mortality were found.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Trial profile. aPatients could transfer from GP back to the surgeon at any point in time for any reason. No patients were lost to follow-up or withdrew their consent during follow-up. bPatients received usual care after colon cancer treatment, so there were no transfers from the trial arm. cThese patients had already transferred back to the surgeon in the previous year.
Figure 2.
Figure 2.
Cumulative incidence curves (Aalen-Johansen) for recurrences and deaths according to the intention-to-treat principle. 95% confidence intervals are provided at several points in time (t = 1, 1.5, 2, 2.5, and 3 years of follow-up).
Figure 3.
Figure 3.
Restricted mean duration in each health state over a period of 3 years.
See this image and copyright information in PMC

References

    1. Arnold M, Sierra MS, Laversanne M, et al.Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683-691. - PubMed
    1. The Netherlands Cancer Registry. Comprehensive Cancer Centre the Netherlands (IKNL). https://iknl.nl/kankersoorten/darmkanker/registratie. Accessed April 13, 2022.
    1. Hewitt M, Greenfield S, Stovall E, From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006.
    1. Wieldraaijer T, Duineveld LA, van Asselt KM, et al.; for the ICARE Study Group. Follow-up of colon cancer patients; causes of distress and need for supportive care: results from the ICARE Cohort Study. Eur J Surg Oncol. 2017;43(1):118-125. - PubMed
    1. Emery JD, Shaw K, Williams B, et al.The role of primary care in early detection and follow-up of cancer. Nat Rev Clin Oncol. 2014;11(1):38-48. - PubMed

Publication types