Improving care after colon cancer treatment in The Netherlands, personalised care to enhance quality of life (I CARE study): study protocol for a randomised controlled trial

Abstract

BackgroundIt is expected that in 2020 more than 17,000 cases of colorectal cancer will be diagnosed in The Netherlands. To date, patients are included in a surgeon-led follow-up programme whose main focus is recurrence detection. However, patients often experience multiple physical and psychosocial problems. Currently, these problems are not always encountered. More care by a generalist is suggested as a solution. Furthermore, patients prefer to undergo rehabilitation in their own environment and to be more involved in their own health care. eHealth applications might enhance this. Oncokompas2.0 is an online self-management application which facilitates access to supportive care. This study aims to evaluate primary care follow-up and aftercare in comparison with secondary care follow-up and aftercare for patients with colon cancer. Second, the added value of Oncokompas2.0 to care will be assessed.Methods/DesignThis is a multi-centre 2 × 2 factorial randomised controlled trial with a calculated sample size of 300 patients. Patients with stage I, II, or III colon carcinoma are eligible. Patients will be randomly assigned in four groups: (1) usual follow-up visits and aftercare provided in secondary care, (2) usual follow-up visits and aftercare provided in secondary care with additional use of Oncokompas2.0, (3) follow-up and aftercare in primary care, and (4) follow-up and aftercare in primary care with additional use of Oncokompas2.0. The primary outcome is quality of life. Secondary outcomes include physical outcomes, psychosocial outcomes, number of investigations, referrals and related communication between secondary and primary care, (time of) recurrence detection and protocol adherence, attention to preventive care, self-management of patients, patient satisfaction, and preference of care at the end of the trial. Data collection will be done by questionnaires and extractions from electronic medical records.DiscussionThe results of this study will provide evidence, which has been scarce to date, on prominent general practitioner involvement in care for colon cancer patients after initial treatment. Also, it evaluates the efficacy of an eHealth application to enhance patient empowerment.Dutch trial registerNTR4860 (registered on 2 October 2014)

Acceptability, quality of life and cost overview of a remote follow-up plan for patients with colorectal cancer

“…Patient organizations, physicians and governments call for more patient-centered solutions that focus on quality of life (QoL) and patient satisfaction. A more central role for patients in their follow-up care improves emotional and social wellbeing and gives them more autonomy and self-efficacy [7]. From both patient and health care provider perspectives, there is willingness to provide alternative follow-up [8].…”

Introducing a time out consultation with the general practitioner between diagnosis and start of colorectal cancer treatment: Patient‐reported outcomes

“…In the Netherlands, however, GPs are currently only mainly involved in the diagnostic and palliative stages of cancer care. For this reason, projects have recently started expanding GP involvement in other stages of cancer care, such as treatment decision-making and survivorship care after treatment (Duineveld et al, 2015;Perfors et al, 2018;de Wit, 2017).…”

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

“…From a patient perspective, there is also willingness regarding non-physician follow-up such as GP-led or nurse-led follow-up [17][18][19]. Different views exist regarding a central the role of GPs in CRC follow-up.…”