Improving Care After colon canceR treatment in the Netherlands
- Personalised care to Enhance quality of life -

Rationale

It is expected that in 2020 more than 17.000 patients with colorectal cancer will be diagnosed in the Netherlands. To date, after initial treatment patients are included in a surgeon-led programme with the main focus on recurrence detection. However, patients often experience multiple physical and psychosocial problems in this phase. Currently, in secondary care these problems are not always encountered and only a small number of distressed patients are identified and supported. Both the Dutch Health Council as the Dutch Cancer Foundation suggested more generalist care as a solution. Furthermore, for patients it would be preferable to be able to undergo rehabilitation as much as possible in their own environment. Evidence shows that web-based interventions for patient empowerment can improve care. An important development of these e-health facilities is the OncoKompas which is an e-health application which facilitates direct-to-user delivery of individualised healthcare.



Objective and hypothesis
The above mentioned developments are subject to the I CARE study. We hypothesize that general practitioner (GP) involvement improves both aftercare and preventive care resulting in improved quality of life and patients’ satisfaction. Furthermore, a GP-led recurrence detection programme leads to at least equal detection of recurrences. Also we hypothesize that the implementation of an e-health application (OncoKompas) to support patients in managing their own revalidation and aftercare and adapting to a healthier life leads to more attention for multi-morbidity, preventive care resulting in an improved quality of life and patients’ satisfaction. Finally, we hypothesize that GPs responsible for the recurrence detection programme will feel more responsible for aftercare which will enhance revalidation and quality of life.



Study design
The present study proposal consists of a multi-centre 2x2 factorial randomised controlled trial with a calculated total sample size of 300 patients, based on the EORTC QLQ-C30. Patients will be randomised in four groups; 1. usual follow-up visits and aftercare provided in secondary care (surgeon-led), 2. usual follow-up visits and aftercare provided in secondary care with additional use of the e-health application OncoKompas, 3. follow-up and aftercare in primary care (GP-led), and 4. follow-up and aftercare in primary care with additional use of the e-health application OncoKompas.



Study population
Patients with stage I, II, and III carcinoma located in the colon and rectosigmoid are eligible. Patients with temporary stoma and who receive adjuvant chemotherapy are also eligible.



Main study parameters/endpoints
Primary outcomes include quality of life and patient satisfaction. Secondary outcomes include physical outcomes, psychosocial outcomes, number of investigations, referrals and related communication between secondary and primary care, (time of) recurrence detection and protocol adherence, attention to preventive care, cost effectiveness, and preference of care at the end of the trial.

We hypothesize that general practitioner (GP) involvement improves both aftercare and preventive care resulting in improved quality of life and patients’ satisfaction. Furthermore, a GP-led recurrence detection programme leads to at least equal detection of recurrences. Also we hypothesize that the implementation of an e-health application (OncoKompas) to support patients in managing their own revalidation and aftercare and adapting to a healthier life leads to more attention for multi-morbidity, preventive care resulting in an improved quality of life and patients’ satisfaction. Finally, we hypothesize that GPs responsible for the recurrence detection programme will feel more responsible for aftercare which will enhance revalidation and quality of life.

3, 6, 12, 24, 36, 48, and 60 months

Aftercare after treatment of colon cancer in secondary care (usual care) or primary care.

Use of an interactive website (OncoKompas 2.) in half of patients