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

Abstract

Background In the I CARE study, colon cancer patients were randomized to receive follow-up care from either general practitioner (GP) or 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 randomized to the GP and 162 to the surgeon. Patients were male (67%) with a mean age of 68.0 years (SD 8.4). During follow-up, 46 recurrences were detected; 18 in the GP (13%) versus 28 in the surgeon group (17%). Most recurrences were detected via abnormal follow-up tests (74%) and treated with curative intent (59%). HR for recurrence was 0.75 [95% CI 0.41-1.36] in GP versus surgeon group. Patients in the GP group remained in the disease-free state slightly longer (2.76 versus 2.71 years). 38 patients died during follow-up; 15 in the GP (11%) versus 23 in the surgeon group (14%). 21 deaths (55%) were related to colon cancer. There were no differences in overall deaths between the groups (HR 0.76 [95% CI 0.39-1.46]). Conclusion Follow-up provided by GPs versus surgeons leads to similar detection of recurrences. Also, no differences in mortality were found.

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

“…Barriers included, among others, a lack of knowledge and experience of GPs and the amount of extra work for GPs. Another concern was the timeliness and appropriateness of follow-up testing by GPs, resulting in potential problems with delayed diagnosis of recurrences [45]. GPs will therefore require additional time, additional personnel and financial compensation to provide this type of care for all cancer patients.…”