In a 1-year interim analysis of a Dutch study (I CARE) reported in The Lancet Oncology, Vos et al found no clinically meaningful difference in changes in quality of life from baseline among patients with colon cancer with general practitioner– vs surgeon-led survivorship care. In addition, researchers found no differences in quality of life with use vs no use of the eHealth app Oncokompas.
Oncokompas is a web-based self-management app aimed at increasing knowledge of the effects of cancer on patients and facilitating access to supportive care.
Study Details
In the open-label, multicenter, 2 x 2 factorial study, 353 eligible patients receiving primary surgical treatment for stage I to III colon cancer or rectosigmoid carcinoma underwent random assignment between March 2015 and November 2018. Of these, 50 participants withdrew early (27 patient decisions and 23 general practitioner withdrawals). The remaining 303 patients were randomly assigned 1:1:1:1 to surgeon-led care (n = 79), surgeon-led care with access to Oncokompas (n = 83), general practitioner–led care (n = 73), or general practitioner–led care with access to Oncokompas (n = 68).
The primary endpoint of the trial was quality of life at 5 years, as measured by the change from baseline in the EORTC QLQ-C30 summary score. A change in quality-of-life score of 10 points was considered clinically meaningful.
In terms of quality of life, general practitioner–led survivorship care can be considered as an alternative to surgeon-led care within the first year after colon cancer treatment. Other outcomes, including patient and physician preferences, will be important for decisions about the type of survivorship care.— Vos et al
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Key Findings
Median follow-up for the interim analysis was 12.2 months (interquartile range = 12.0–13.0 months).
For the general practitioner–led groups (n = 141) vs the surgeon-led groups (n = 162), mean QLQ-C30 summary scores at baseline (after surgery) were 90.2 vs 86.1, and mean changes from baseline at 12 months were +1.6 vs + 3.9 (difference = –2.3, P = .094).
For the Oncokompas groups (n = 151) vs no Oncokompas groups (n = 152), mean QLQ-C30 summary scores at baseline were 87.4 vs 88.6, and mean changes from baseline at 12 months were +2.9 vs +2.9 (difference = –0.1, P = .97).
Among QLQ-C30 domains, statistically significant differences were observed only in the role functioning domain (P = .022) and global health domain (P = .037), both in favor of the surgeon-led vs general practitioner–led groups. No significant differences were observed in symptom domains in the general practitioner– vs surgeon-led groups, and no differences in functional or symptom domains were observed for the Oncokompas vs no Oncokompas groups.
The investigators concluded, “In terms of quality of life, general practitioner–led survivorship care can be considered as an alternative to surgeon-led care within the first year after colon cancer treatment. Other outcomes, including patient and physician preferences, will be important for decisions about the type of survivorship care.”
Julien A.M. Vos, MD, of the Department of General Practice, Amsterdam UMC, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Dutch Cancer Society. For full disclosures of the study authors, visit thelancet.com.
