General practice vs surgical-based follow-up for patients with colon cancer : randomised controlled trial

• Published in: British journal of cancer Vol. 94; no. 8; pp. 1116 - 1121
• Main Authors: WATTCHOW, D. A, WELLER, D. P, ESTERMAN, A, PILOTTO, L. S, MCGORM, K, HAMMETT, Z, PLATELL, C, SILAGY, C
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 24.04.2006
• Subjects: Aged; Aged, 80 and over; Anxiety - diagnosis; Australia; Biological and medical sciences; Clinical Study; Colonic Neoplasms - diagnosis; Colonic Neoplasms - surgery; Continuity of Patient Care; Depression - diagnosis; Family Practice - statistics & numerical data; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General Surgery - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; Outcome and Process Assessment, Health Care - methods; Outcome and Process Assessment, Health Care - statistics & numerical data; Patient Satisfaction; Quality of Life; Recurrence; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Rate; Tumors; Australia; Human; investigations; Malignant tumor; Quality of life; Colonic disease; Colon cancer; Cancerology; Treatment; Surgery; general practice; Randomised controlled trial; Digestive diseases; Intestinal disease; colon cancer follow-up; Comparative study
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6603052

This trial examined the optimal setting for follow-up of patients after treatment for colon cancer by either general practitioners or surgeons. In all, 203 consenting patients who had undergone potentially curative treatment for colon cancer were randomised to follow-up by general practitioners or surgeons. Follow-up guidance recommended three monthly clinical review and annual faecal occult blood tests (FOBT) and were identical in both study arms. Primary outcome measures (measured at baseline, 12 and 24 months were (1) quality of life, SF-12; physical and mental component scores, (2) anxiety and depression: Hospital Anxiety and Depression Scale and (3) patient satisfaction: Patient Visit-Specific Questionnaire. Secondary outcomes (at 24 months) were: investigations, number and timing of recurrences and deaths. In all, 170 patients were available for follow-up at 12 months and 157 at 24 months. At 12 and 24 months there were no differences in scores for quality of life (physical component score, P=0.88 at 12 months; P=0.28 at 24 months: mental component score, P=0.51, P=0.47; adjusted), anxiety (P=0.72; P=0.11) depression (P=0.28; P=0.80) or patient satisfaction (P=0.06, 24 months). General practitioners ordered more FOBTs than surgeons (rate ratio 2.4, 95% CI 1.4-4.4), whereas more colonoscopies (rate ratio 0.7, 95% CI 0.5-1.0), and ultrasounds (rate ratio 0.5, 95% CI 0.3-1.0) were undertaken in the surgeon-led group. Results suggest similar recurrence, time to detection and death rates in each group. Colon cancer patients with follow-up led by surgeons or general practitioners experience similar outcomes, although patterns of investigation vary.