Characteristics of (a) primary versus secondary care follow-up studies and (b) GP involvement in conventional follow-up studies.
| Study | Participants | Interventions | Length of follow-up | Outcomes |
|---|---|---|---|---|
| (a) Studies of GP follow-up | ||||
| Grunfeld et al, 1996.3 UK, RCT | 296 women with stage I-III breast cancer in remission (completed treatment ≥3 months previously). Mean age 61 years. Mean time since diagnosis: 3.4 years | GP follow-up, n = 148 Conventional hospital follow-up, n = 148 | 18 months | Diagnostic delay; SF-36; HADS; EORTC; mean number of visits; mean length of each visit; mean total time for follow-up visits; tests ordered; costs |
| Grunfeld et al, 2006.27 Canada Non-inferiority RCT | 968 patients with early-stage breast cancer in remission. Mean age 61 years. Time since diagnosis: 9–15 months | GP follow-up, n = 483 Conventional hospital follow-up, n = 485 | Median 3.5 years. Patients observed until 5 years after randomisation or until 30 June 2003, whichever came first; 32% observed for 5 years | Death (all causes); recurrence related serious adverse event; recurrence rate; SF-36, HADS |
| Wattchow et al, 2006.30 Australia, RCT | 203 patients with colon cancer (Dukes A, B, or C). 58% were male, 13% were under 60 years of age, and 19% over 80 years. Mean time since diagnosis was not stated; patients recruited and randomised after completing treatment | GP follow-up, n = 97 Conventional hospital follow-up, n = 106 | 24 months | Death rate (per 1000 months on trial); recurrence rate (per 1000 months on trial); time to detection of recurrence (median); SF-12; HADS; patient satisfaction; number of follow-up visits (mean); number and type of investigations (blood tests, FOB tests, colonoscopies, and radiological investigations) |
| (b) Studies examining | ||||
| Holtedahl et al, 2005.31 Norway, RCT | 91 cancer patients diagnosed with primary (n = 78) or relapsing (n = 13) cancer; 77 treated with curative intent. Mean age 62 years; 44% male. Patients were invited to participate after completing therapy | Increased contact with the patients' GPs soon after cancer treatment (invitation to two consultations with their GP and advised to contact GP with any problems). Also received routine hospital follow-up, n = 41; conventional hospital follow-up, n = 50 | 6 months (from diagnosis) | EORTC QLQ C-23; GP consultation |
| Johansson et al, 2001.32 Sweden, RCT | 527 newly diagnosed cancer patients. Included sites: breast, prostate, colorectal, and gastric. Only 510 followed-up; 16 discontinued before receiving information about randomisation and 1 died. For those who completed the trial (n = 416) the age was 63 years and 34% were male | Individual support starting at diagnosis: intensified primary healthcare (IPH), nutritional support, and psychological support. IPH extended information from specialist clinics, education and supervision in cancer care for GPs, and home-care nurses. Patients were referred by the project team to a home-care nurse and the GP informed of the referral, n = 260. Standard care, n = 250 | Utilisation of specialist care: 3 months (from diagnosis). Frequency of contacts with home-care nurse: 6 months (from diagnosis; intervention, n = 178; control, n = 178). (Note: study published in multiple publications) | Number of patients who had contact with home-care nurse (at 6 months); hospital admissions (at 3 months); days in hospital (at 3 months); visits to outpatient (at 3 months); acute hospital admissions (at 3 months); acute outpatient visits (at 3 months); frequency of contact with home-care nurse (at 6 months) |
| Nielsen et al, 2003.33 Denmark, RCT | 248 newly diagnosed cancer patients; 183 had local/locoregional disease. Cancer site: breast, gastrointestinal, germinal cell, head and neck, bladder and kidney, ovarian and cervix, sarcoma, malignant melanoma, brain, lung, and miscellaneous. 32% were 18–49 years of age and 36% were male | Shared care programme: transfer of knowledge from the oncologist to the GP (discharge summary letters according to study guidelines), improved communication between parties (provision of name and contact details of hospital doctors and nurses), and active patient involvement (patients advised to to visit GP with problems), n = 127. Conventional hospital care: no usual procedure of informing GPs of newly diagnosed patients, discharge summary letter (not following guidelines) sent at end of treatment period, n = 121 | 6 months | HRQL/performance status; contact with GP; information from GP; care from GP; GPs' knowledge; global assessment of the GP; intersectorial cooperation (primary sector and department of oncology); global assessment of intersectorial cooperation; feeling of not being left in limbo; global assessment of perception of ‘not being left in limbo’ |
EORTC = European Organisation for Research and Treatment for Cancer. EORTC QLQ-C23 = EORTC Quality of Life Questionnaire Core 23. FOB = faecal occult blood tests. HADS = Hospital Anxiety and Depression Scale. HRQL = Health related quality of life. RCT = randomised controlled trial. SF-12 = Short Form 12-Item General Health Questionnaire. SF-36 = Short Form 36-Item General Health Questionnaire.