Primary healthcare use during follow-up after curative treatment for colorectal cancer

Abstract

The rising number of colorectal cancer (CRC) survivors is likely to impose a burden on healthcare systems. Effective resource allocation between primary and hospital care to ensure ongoing high-quality care is under discussion. Therefore, it is important to understand the current role of GPs during follow-up care of CRC. This study explores the primary healthcare use of patients 2-6 years after CRC treatment. Annual rates of face-to-face contacts, prescribed medication and referrals were compared between CRC patients and age, gender and GP matched controls in a historical prospective study. Reasons for contacts and prescribed medication were compared based on International Classification of Primary Care and Anatomical Therapeutic Chemical (ATC) Classification System codes, respectively. Negative binomial regression models and non-parametric test were used. Patients showed significantly more face-to-face contacts in the 2nd (63%), 3rd (32%) and 6th (23%) year, more drug prescriptions in the 2nd, 3rd and 6th year, and more referrals in the 2nd and 5th year after diagnosis. Differences in contacts and medication were related to the alimentary tract, blood and blood-forming organs, and psychological problems. This study suggests that GPs already play a substantial role during CRC follow-up and that there may be scope for formal services to be incorporated into the current model of GP care.

Time from incident primary cancer until recurrence or second primary cancer: Risk factors and impact in general practice

“…Increased activity in general practice has been documented for up to 6 years after cancer treatment, which suggests that the GP plays an important role in cancer follow-up (Brandenbarg et al, 2017). Formal involvement of general practice in cancer survivor care may benefit from this.…”

Exploring why patients with cancer consult GPs: a 1-year data extraction

“…However, the increased consultation rates are in line with findings of several studies regarding primary healthcare use among patients with cancer. 3,4,[8][9][10]18 A Dutch study comprising several cancer types found that, compared with matched controls, patients with cancer had significantly more GP consultations (3.5 versus 2.7 per year). 18 A UK study found that patients with breast and colorectal cancer had one more GP consultation per year compared with controls, up to 5 years after diagnosis for breast cancer, and up to 9 years for colorectal cancer.…”

“…9 Other, Dutch studies found that patients with colorectal cancer had 54% more face-to-face contacts with GPs compared with reference patients in the first year after diagnosis, 8 as well as significantly more face-to-face contacts in the second, third, and sixth year after diagnosis. 3 Studies trying to explain the cause of the increased consultation rates among patients with cancer have shown conflicting results. Jabaaij et al found that patients with cancer more often had a chronic comorbid condition than their matched controls, and concluded that having a chronic condition increased healthcare use.…”

“…This traditional follow-up model faces challenges owing to increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs. [1][2][3][4] GPs have reported broad experience in providing follow-up care to patients with cancer, 2,5 and some randomised studies indicate that hospital-based follow-up provides no advantages compared with follow-up in primary care in terms of detection of recurrence or quality of life. 1,6,7 Furthermore, when compared with the general population, studies among patients with colorectal, prostate, and breast cancer have shown that they have higher primary healthcare use during the first years following the diagnosis of cancer.…”

“…1,6,7 Furthermore, when compared with the general population, studies among patients with colorectal, prostate, and breast cancer have shown that they have higher primary healthcare use during the first years following the diagnosis of cancer. 3,4,8,9 A Danish study among 127 000 patients with cancer showed that they had 43-73% more GP consultations compared with the reference population 12 months after their diagnosis. 10 It was hypothesised that, in addition to regular follow-up visits in hospitals, patients with cancer seek their GPs both for cancer-related problems and for other reasons.…”