General practitioner-led vs surgeon-led colon cancer survivorship care: a randomized clinical trial

Abstract

The randomized controlled I CARE (Improving Care After colon canceR treatment in the Netherlands) trial evaluated the impact of general practitioner-led vs surgeon-led survivorship care on quality of life (QoL) in colorectal cancer survivors, alongside the effect of the eHealth application Oncokompas. The trial was conducted in 8 hospitals and 225 general practices across the Netherlands, including 303 patients who underwent surgery for stage I-III colon cancer or rectosigmoid carcinoma. Patients were randomly assigned into 4 groups: surgeon-led care, surgeon-led care with Oncokompas, general practitioner-led care, and general practitioner-led care with Oncokompas. QoL was assessed at multiple time points over 60 months. At 60 months, no clinically relevant differences in QoL were found between general practitioner-led and surgeon-led care (difference in summary score = -0.5, 95% CI = -1.6 to 0.5) or with Oncokompas (difference = 0.8, 95% CI = 0.0 to 1.6). In conclusion, neither general practitioner involvement nor access to Oncokompas led to clinically relevant improvements in long-term QoL. Survivorship care can be tailored to preferences. Netherlands Trial Register; NTR4860.

Figure 1.

Overall change in quality of life (QoL) for general practitioner–led vs surgeon-led survivorship care as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)–C30 (A and C) and -CR29 questionnaires (B and D). For functional scores, higher scores indicated better QoL, hence positive changes over time (upward bars) indicated improvement from baseline, whereas for symptoms, higher scores indicated greater severity of symptoms, and hence negative changes (downward bars) indicated improvement (or decrease of symptoms). The QoL changes were estimated using piecewise linear mixed-effects models with 1 knot at 24 months. A) and (B) shows QoL changes from baseline to 24 months, whereas (C) and (D) shows QoL changes from 24 to 60 months. There were no clinically relevant differences. P values (<.05) are shown for the between-group comparison of the overall change from baseline. *Values and estimates for patients without a stoma are shown.