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

Abstract

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.

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

“…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 8 . In the same study there were no statistically significant differences between groups based on Functional Assessment of Cancer Therapy—colorectal (FACT‐C) and FACT‐C/Treatment Outcome Index (TOI) 29 …”

“…Two studies were included (Sweden, n = 107 28 and Denmark, n = 336 8,29 ). In the Swedish RCT, patients in the PIFU arm were instructed to contact the surgical department if they had any symptoms and it was also recommended they leave faecal samples with the district nurse at regular intervals 28 .…”

“…Eight were identified across 15 systematic reviews that included at least one RCT of PIFU compared with another FU model, 2,3,5,6,12,[15][16][17][18][19][20][21][22] and two from the supplementary searches (Figure 1 PRISMA flowchart). This included six RCTs in breast cancer, 7,[23][24][25][26][27] two in colorectal cancer reported in three publications, 8,28,29 one in endometrial cancer 30 and one in melanoma 31 (see Supplementary material for excluded studies).…”

“…8 In the same study there were no statistically significant differences between groups based on Functional Assessment of Cancer Therapy-colorectal (FACT-C) and FACT-C/Treatment Outcome Index (TOI). 29…”

Variation in Follow-Up after Radical Cystectomy for Bladder Cancer—An Inventory Roundtable and Literature Review

“…Also, it will be essential to maximize patient engagement, involve patients in the decision-making process, and consider their preferences and expectations when designing follow-up strategies [20]. Indeed, evidence suggests that patient-led and individually tailored follow-up is acceptable and does not compromise outcomes [21].…”