Detection of colon cancer recurrences during follow-up care by general practitioners vs surgeons.

Autor:	Vos JAM; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Research Programme Quality of Care, and Personalized Medicine, Amsterdam, the Netherlands., Sert E; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Busschers WB; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Duineveld LAM; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Wieldraaijer T; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Wind J; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Donkervoort SC; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., Govaert MJPM; Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands., Beverdam FH; Department of Surgery, Franciscus Gasthuis & Vlietland Hospital, Schiedam, the Netherlands., Smits AB; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands., Bemelman WA; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Heuff G; Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands., van Weert HCPM; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Research Programme Quality of Care, and Personalized Medicine, Amsterdam, the Netherlands., van Asselt KM; Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Research Programme Quality of Care, and Personalized Medicine, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of the National Cancer Institute [J Natl Cancer Inst] 2023 May 08; Vol. 115 (5), pp. 523-529.
DOI:	10.1093/jnci/djad019
Abstrakt:	Background: In the I CARE study, colon cancer patients were randomly assigned to receive follow-up care from either a general practitioner (GP) or a surgeon. Here, we address a secondary outcome, namely, detection of recurrences and effect on time to detection of transferring care from surgeon to GP. Methods: Pattern, stage, and treatment of recurrences were described after 3 years. Time to event was defined as date of surgery, until date of recurrence or last follow-up, with death as competing event. Effects on time to recurrence and death were estimated as hazard ratios (HRs) using Cox regression. Restricted mean survival times were estimated. Results: Of 303 patients, 141 were randomly assigned to the GP and 162 to the surgeon. Patients were male (67%) with a mean age of 68.0 (8.4) years. During follow-up, 46 recurrences were detected; 18 (13%) in the GP vs 28 (17%) in the surgeon group. Most recurrences were detected via abnormal follow-up tests (74%) and treated with curative intent (59%). Hazard ratio for recurrence was 0.75 (95% confidence interval [CI] = 0.41 to 1.36) in GP vs surgeon group. Patients in the GP group remained in the disease-free state slightly longer (2.76 vs 2.71 years). Of the patients, 38 died during follow-up; 15 (11%) in the GP vs 23 (14%) in the surgeon group. Of these, 21 (55%) deaths were related to colon cancer. There were no differences in overall deaths between the groups (HR = 0.76, 95% CI = 0.39 to 1.46). Conclusion: Follow-up provided by GPs vs surgeons leads to similar detection of recurrences. Also, no differences in mortality were found. (© The Author(s) 2023. Published by Oxford University Press.)
Databáze:	MEDLINE
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