SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer

Jefford, Michael; Emery, Jon D.; James Martin, Andrew; De Abreu Lourenco, Richard; Lisy, Karolina; Grunfeld, Eva; Mohamed, Mustafa Abdi; King, Dorothy; Tebbutt, Niall C.; Lee, Margaret; Mehrnejad, Ashkan; Burgess, Adele; Marker, Julie; Eggins, Renee; Carrello, Joseph; Thomas, Hayley; Schofield, Penelope

doi:10.1016/j.eclinm.2023.102346

Cited by 5 publications

(5 citation statements)

References 50 publications

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“…Meanwhile, patients with a right colon PTL need support especially after metastasectomy and during systemic treatment. This emphasizes the need for survivorship programs [ 73 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

Aho,

Osterlund,

Ristimäki

et al. 2024

Cancers

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The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan–Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.

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“…Meanwhile, patients with a right colon PTL need support especially after metastasectomy and during systemic treatment. This emphasizes the need for survivorship programs [ 73 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

Aho,

Osterlund,

Ristimäki

et al. 2024

Cancers

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“…The shared care intervention followed a study protocol 29 with defined roles for the GP and specialist. However, participants still expressed confusion about the follow-up schedule, and roles and responsibilities of each provider when the model of care was not specialist-led.…”

Section: Communicationmentioning

confidence: 99%

“…SCORE trial investigators 29 developed two sets of semi-structured interview guides, with a shared care set specific for participants in the shared care arm, and a usual care set specific for participants in the usual care arm (Appendices 1 and 2). Development of these guides was informed by implementation outcomes relevant to the individual consumer level, as defined by Proctor et al 26…”

Section: Data Collectionmentioning

confidence: 99%

“…27 Successful implementation of shared survivorship care may be informed by intervention effectiveness and implementation outcomes as defined by Proctor et al 26 The SCORE RCT was designed to evaluate shared care for CRC survivors. 29 In this trial, patients with early-stage colon or rectal cancer treated with curative intent were randomised to usual care follow-up (hospital-based visits 3, 6, 9 and 12 months following end of treatment) or to shared care, which substituted the 3 and 9 month visits with GP visits and added an early GP visit soon after treatment ended. As part of the shared care intervention, participants received additional resources including a survivorship care plan (SCP), a patient information booklet and DVD, and a concerns/question prompt list.…”

Section: Introductionmentioning

confidence: 99%

“…34 Our study formed part of the SCORE trial evaluation. 29 Its primary objective was to explore patients' perspectives on facilitators and barriers to implementing the shared care model for CRC survivors. The secondary objective was to explore patients' experiences receiving survivorship care via telehealth during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study

Gore,

Lisy,

O’Callaghan

et al. 2023

Psycho-Oncology

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ObjectivesThe number of colorectal cancer (CRC) survivors is increasing and current models of survivorship care are unsustainable. There is a drive to implement alternative models of care including shared care between general practitioners (GPs) and hospital‐based providers. The primary objective of this study was to explore perspectives on facilitators and barriers to shared care. The secondary objective was to explore experiences of telehealth‐delivered care.MethodQualitative data were collected via semi‐structured interviews with participants in the Shared Care for Colorectal Cancer Survivors (SCORE) randomised controlled trial. Interviews explored patient experiences of usual and shared survivorship care during the SCORE trial. In response to the COVID pandemic, participant experiences of telehealth appointments were also explored. Interviews were recorded and transcribed for thematic analysis.ResultsTwenty survivors of CRC were interviewed with an even number in the shared and usual care arms; 14 (70%) were male. Facilitators to shared care included: good relationships with GPs; convenience of GPs; good communication between providers; desire to reduce public health system pressures. Barriers included: poor communication between clinicians; inaccessibility of GPs; beliefs about GP capacity; and a preference for follow‐up care with the hospital after positive treatment experiences. Participants also commonly expressed a preference for telehealth‐based follow‐up when there was no need for a clinical examination.ConclusionsThis is one of few studies that have explored patient experiences with shared and telehealth‐based survivorship care. Findings can guide the implementation of these models, particularly around care coordination, communication, preparation, and personalised pathways of care.

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Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review

Pradhan,

Sharman,

Palme

et al. 2024

J Cancer Surviv

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Purpose Rural people with head and neck cancers (HNC) are likely to experience poorer health outcomes due to limited access to health services, so many benefit from models of care that account for rurality. The aim of this review was to synthesise literature on models of care in this population. Methods Studies were identified using seven databases: PubMed, PsycINFO, Scopus, Embase, CINAHL, Medline, and Web of Science. Studies that tested or reported a model of care in rural HNC survivors were included. Data on characteristics and outcomes of the models were synthesised according to the domains in the Cancer Survivorship Care Quality Framework, and study quality was appraised. Results Seventeen articles were included. Eight were randomised controlled trials (seven with a control group and one single-arm study). Three models were delivered online, nine via telehealth, and five in-person. Majority were led by nurses and allied health specialists and most addressed management of physical (n = 9) and psychosocial effects (n = 6), while only a few assessed implementation outcomes such as cost-effectiveness. None evaluated the management of chronic health conditions. Conclusion Positive outcomes were reported for domains of survivorship care that were measured; however, further evaluation of models of care for rural people with HNC is needed to assess effectiveness across all domains of care. Implications for Cancer Survivors Rural cancer survivors are a diverse population with unique needs. Alternative models of care such as shared care, or models personalised to the individual, could be considered to reduce disparities in access to care and outcomes.

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SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer

Cited by 5 publications

References 50 publications

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study

Models of survivorship care in patients with head and neck cancer in regional, rural, and remote areas: a systematic review

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