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
- Author(s)
- Jefford, M; Emery, JD; Martin, AJ; De Abreu Lourenco, R; Lisy, K; Grunfeld, E; Mohamed, MA; King, D; Tebbutt, NC; Lee, M; Mehrnejad, A; Burgess, A; Marker, J; Eggins, R; Carrello, J; Thomas, H; Schofield, P;
- Journal Title
- eClinicalMedicine
- Publication Type
- Research article
- Abstract
- BACKGROUND: SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. METHODS: The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. FINDINGS: 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. INTERPRETATION: SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. FUNDING: Victorian Cancer Agency and Cancer Australia.
- Keywords
- Colorectal neoplasms; General practice; Model of care; Randomised controlled trial; Shared care; Survivors
- Department(s)
- Health Services Research; Australian Cancer Survivorship Centre
- Publisher's Version
- https://doi.org/10.1016/j.eclinm.2023.102346
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-01-19 02:53:33
Last Modified: 2024-07-09 06:22:50