Patient-led follow-up reduces outpatient doctor visits and improves patient satisfaction. One-year analysis of secondary outcomes in the randomised trial Follow-Up after Rectal CAncer (FURCA)

Jakobsen, Ida Hovdenak; Thaysen, Henriette Vind; Laurberg, Søren; Johansen, Christoffer; Juul, Therese

doi:10.1080/0284186x.2021.1950924

Cited by 5 publications

(28 citation statements)

References 28 publications

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“…for post-operative complications). 8 In the other study 35% of patients in the PIFU arm did not have any contact at all after randomisation, whereas there was 98% compliance in the routine FU arm. 28 3.3.4 | Patient satisfaction and quality of life Patient involvement and satisfaction score were significantly higher in the PIFU arm for 2/6 (involvement) and 5/5 (satisfaction) items, respectively, based on one study.…”

Section: Adherence To Pifu or Routine Fu Protocolsmentioning

confidence: 88%

“…11 In one colorectal cancer study, 38% in the PIFU arm had planned routine clinic visits in non-compliance with the protocol and/or because it was deemed clinically necessary. 8 There is a concern with PIFU that patients may not always request urgent appointments despite recognising symptoms, 38,39 and in such cases regular follow-up may aid access to specialists. 16,40 There are limitations to this review.…”

Section: Discussionmentioning

confidence: 99%

“…We know that RCTs often have stringent inclusion criteria which do not reflect the heterogeneity of real-world populations. 41 In the trials included in this review, patients were deemed to be ineligible where they had, for example, psychosocial problems, 23,27 were not fluent in the native language of where the study was set, 8,24 had stage III or IV breast cancer, 25 had cognitive impairment, 8,27,31 did not have computer skills or a compatible smartphone, 27,31 had a tumour with high risk histology or were undergoing treatment with radiation therapy, 30 had a synchronous cancer 8 or inflammatory bowel disease. 28 Studies were set in the United Kingdom (n = 4), Denmark (n = 3), Sweden (n = 2) and Australia (n = 1).…”

Section: Discussionmentioning

confidence: 99%

“…Despite foregoing regular outpatient visits, some models of PIFU include regular imaging, for example in breast 7 and colorectal cancer. 8 There is uncertainty however around the effectiveness and cost-effectiveness of PIFU. It is thought that PIFU may reduce diagnostic delay by enabling more rapid access to specialist care when needed.…”

Section: Introductionmentioning

confidence: 99%

“…Patients are provided with information on signs and symptoms of recurrence to help them decide when to initiate contact with a designated health care professional (such as a specialist nurse). Despite foregoing regular outpatient visits, some models of PIFU include regular imaging, for example in breast 7 and colorectal cancer 8 …”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Dretzke,

Chaudri,

Balaji

et al. 2023

Cancer Medicine

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BackgroundThe traditional cancer follow‐up (FU) model for cancer survivors is by scheduled clinic appointments; however, this is not tailored to patient needs and is becoming unsustainable. Patient‐initiated follow‐up (PIFU) may be a more effective and flexible alternative. This systematic review aims to analyse all existing evidence from randomised controlled trials (RCTs) on the effectiveness of PIFU compared with other FU models that include routinely scheduled appointments in adults who have been treated with curative intent for any type of cancer.MethodsStandard systematic review methodology aimed at limiting bias was used for study identification, selection and data extraction. MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and Epistemonikos were searched for systematic reviews to March 2022, and Cochrane CENTRAL was searched for RCTs from 2018 (April 2023). Ongoing trial registers were searched (WHO ICTRP, ClinicalTrials.gov, April 2023). Eligible studies were randomised controlled trials comparing PIFU with an alternative FU model in adult cancer survivors. Risk of bias assessment was via the Cochrane risk of bias tool‐2. Meta‐analysis was precluded by clinical heterogeneity and results were reported narratively.ResultsTen RCTs were included (six breast, two colorectal, one endometrial cancer and one melanoma, total n = 1754); all studies had risk of bias concerns, particularly relating to how missing data were handled, and populations were unlikely to be representative. Limited findings in breast cancer suggested that type of FU does not affect recurrence detection or patient‐related outcomes, while PIFU may reduce the number of clinic visits. Adding patient‐led surveillance to routine FU may increase melanoma detection. Evidence for other types of cancer is too limited to draw firm conclusions.ConclusionsPIFU may be a viable FU model in breast cancer, but further research is needed for other types of cancer and on long‐term outcomes. A protocol was registered with PROSPERO (CRD42020181424).

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Section: Adherence To Pifu or Routine Fu Protocolsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Dretzke,

Chaudri,

Balaji

et al. 2023

Cancer Medicine

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Quality of life and symptom burden after rectal cancer surgery: a randomised controlled trial comparing patient-led versus standard follow-up

Hovdenak,

Thaysen,

Bernstein

et al. 2023

J Cancer Surviv

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Purpose After curatively intended rectal cancer (RC) surgery, new follow-up strategies are warranted, seeking more individualised care and targeting health-related quality of life (HRQoL) and functional outcomes. The FURCA trial aimed to investigate the effect of patient-led follow-up on HRQoL and symptom burden 3 years after surgery. Methods RC patients from four Danish centres were randomised 1:1 to intervention (patient-led follow-up with patient education and self-referral to a specialist nurse) or control (standard follow-up with five routine doctor visits). Patients in both groups had a computed tomography (CT) at 1 and 3 years. The primary outcome (HRQoL) was assessed by the Functional Assessment of Cancer Therapy – colorectal (FACT-C) score (Ward et al. in Qual Life Res. 8(3):181-95, 18). Secondary outcomes were functional measures, patient involvement and satisfaction and cancer recurrence at 3 years. Results From Feb 2016 to Aug 2018, 336 patients were included of whom 248 completed 3 years of follow-up. Between-group differences were found neither for the primary endpoint, nor for functional outcomes. The recurrence rate did not differ between the groups. Patient involvement and satisfaction were higher in the intervention group with statistical significance in almost half of the items. Conclusions We found no effect on HRQoL and symptom burden from patient-led follow-up, although it may improve patient-perceived involvement and satisfaction. Implications for Cancer Survivors The findings in this study suggest that patient-led follow-up is a more tailored approach to meet cancer survivors’ needs and might improve their ability to cope with survivorship. ClinicalTrials.gov identifier R97-A6511-14-S23.

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Assessment of Quality of Life in Rectal Cancer with Organ-Preservation Treatment: Are We There yet?

Baird¹,

Steinke²,

Minnaar³

et al. 2023

Clinical Oncology

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Patient-led follow-up reduces outpatient doctor visits and improves patient satisfaction. One-year analysis of secondary outcomes in the randomised trial Follow-Up after Rectal CAncer (FURCA)

Cited by 5 publications

References 28 publications

A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Quality of life and symptom burden after rectal cancer surgery: a randomised controlled trial comparing patient-led versus standard follow-up

Assessment of Quality of Life in Rectal Cancer with Organ-Preservation Treatment: Are We There yet?

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