Detection of colon cancer recurrences during follow-up care by general practitioners vs surgeons.
Journal
Journal of the National Cancer Institute
ISSN: 1460-2105
Titre abrégé: J Natl Cancer Inst
Pays: United States
ID NLM: 7503089
Informations de publication
Date de publication:
08 05 2023
08 05 2023
Historique:
received:
05
10
2022
revised:
02
01
2023
accepted:
09
01
2023
medline:
9
5
2023
pubmed:
31
1
2023
entrez:
30
1
2023
Statut:
ppublish
Résumé
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. 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. 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). Follow-up provided by GPs vs surgeons leads to similar detection of recurrences. Also, no differences in mortality were found.
Sections du résumé
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.
Identifiants
pubmed: 36715623
pii: 7009235
doi: 10.1093/jnci/djad019
pmc: PMC10165489
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
523-529Investigateurs
A A W van Geloven
(AAW)
A W H van de Ven
(AWH)
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press.
Références
BMJ. 1996 Sep 14;313(7058):665-9
pubmed: 8811760
Int J Colorectal Dis. 2021 Nov;36(11):2399-2410
pubmed: 33813606
Trials. 2015 Jun 26;16:284
pubmed: 26112050
J Clin Oncol. 2006 Feb 20;24(6):848-55
pubmed: 16418496
Lancet. 2022 Apr 16;399(10334):1551-1560
pubmed: 35430022
BJGP Open. 2021 Feb 23;5(1):
pubmed: 33172850
Clin Colorectal Cancer. 2019 Jun;18(2):e223-e228
pubmed: 30792036
BMC Cancer. 2020 Jan 6;20(1):22
pubmed: 31906899
J Cancer Surviv. 2016 Dec;10(6):990-1011
pubmed: 27138994
Int J Colorectal Dis. 2008 Nov;23(11):1081-7
pubmed: 18688621
BMJ Open. 2021 Aug 24;11(8):e048985
pubmed: 34429313
JAMA Oncol. 2017 Dec 1;3(12):1692-1696
pubmed: 28975263
Nat Rev Clin Oncol. 2014 Jan;11(1):38-48
pubmed: 24247164
Br J Cancer. 2006 Apr 24;94(8):1116-21
pubmed: 16622437
J Cancer Surviv. 2022 Apr;16(2):279-302
pubmed: 33763806
Br J Gen Pract. 2023 Jan 26;73(727):e115-e123
pubmed: 36316164
BMC Prim Care. 2022 Jan 17;23(1):13
pubmed: 35172743
J Cancer Surviv. 2021 Feb;15(1):66-76
pubmed: 32815087
Lancet Oncol. 2015 Sep;16(12):1231-72
pubmed: 26431866
Eur J Surg Oncol. 2017 Jan;43(1):118-125
pubmed: 27633339
Gut. 2017 Apr;66(4):683-691
pubmed: 26818619
Cochrane Database Syst Rev. 2019 Nov 21;2019(11):
pubmed: 31750936
Lancet Oncol. 2021 Aug;22(8):1175-1187
pubmed: 34224671
J Clin Oncol. 2016 Oct 1;34(28):3474-6
pubmed: 27507871
BMJ Open. 2013 Apr 04;3(4):
pubmed: 23564936