Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial
- Knut Magne Augestad1,2,3,
- Jan Norum3,4,
- Stefan Dehof5,
- Ranveig Aspevik5,
- Unni Ringberg6,
- Torunn Nestvold7,
- Barthold Vonen3,7,
- Stein Olav Skrøvseth1,
- Rolv-Ole Lindsetmo2,3
- 1Norwegian Center of Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- 2Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- 3Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- 4Northern Norway Regional Health Authority Trust, Bodø, Norway
- 5Department of Surgery, Helgeland Hospital, Mo i Rana, Norway.
- 6Nordbyen Primary Care Office, Tromsø, Norway
- 7Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Correspondence to Dr Knut Magne Augestad;
- Received 22 November 2012
- Revised 28 January 2013
- Accepted 14 February 2013
- Published 4 April 2013
Objective To assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient's quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up.
Design Randomised controlled trial.
Setting Northern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities.
Participants Patients surgically treated for colon cancer, hospital surgeons and community GPs.
Intervention 24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used.
Main outcome measures Primary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses.
Results 110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ−2.23, p=0.20; EQ-5D index; Δ−0.10, p=0.48, EQ-5D VAS; Δ−1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001).
Conclusions GP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings.
Trial registration ClinicalTrials.gov identifier NCT00572143.
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