Enhanced involvement of general practitioners in cancer rehabilitation: a randomised controlled trial

Stinne Holm Bergholdt, Pia Veldt Larsen, Jakob Kragstrup, Jens Søndergaard, Dorte Gilså Hansen, Stinne Holm Bergholdt, Pia Veldt Larsen, Jakob Kragstrup, Jens Søndergaard, Dorte Gilså Hansen

Abstract

Objective: To test the hypothesis that a multimodal intervention giving the general practitioner (GP) an enhanced role in cancer rehabilitation improves patients' health-related quality of life and psychological distress.

Design: Cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention group or to a control group. Patients were subsequently allocated to intervention or control (usual procedures) based on the randomisation status of their GP.

Setting: All clinical departments at a public regional hospital treating cancer patients and all general practices in Denmark.

Participants: Adult patients treated for incident cancer at Vejle Hospital, Denmark, between 12 May 2008 and 28 February 2009. A total of 955 patients (486 to the intervention group and 469 to the control group) registered with 323 general practices were included.

Intervention: The intervention included an interview about rehabilitation needs with a rehabilitation coordinator at the regional hospital, information from the hospital to the GP about individual needs for rehabilitation and an encouragement of the GP to contact the patient to offer his support with rehabilitation.

Main outcome measures: The primary outcome was health-related quality of life measured 6 months after inclusion using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Secondary outcomes included quality of life at 14 months and additional subscales of the EORTC QLQ-C30 at 6 and 14 months and psychological distress at 14 months using the Profile of Mood States Scale.

Results: No effect of the intervention was observed on primary and/or secondary outcomes after 6 and 14 months.

Conclusion: A multimodal intervention aiming to give the GP an enhanced role in cancer patients' rehabilitation did not improve quality of life or psychological distress.

Trial registration: ClinicalTrials.gov, registration ID number NCT01021371.

Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Study flow. GP, general practitioner.

References

    1. Mikkelsen TH, Sondergaard J, Jensen AB, et al. Cancer rehabilitation: psychosocial rehabilitation needs after discharge from hospital? Scand J Prim Health Care 2008;26:216–21
    1. Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Comittee on Cancer Survivorship. Improving Care and Quality of Life, National Cancer Policy Board, Institute of Medicine, and National Research COUNCIL. Washington, DC: The National Academies Press, 2006
    1. Groenvold M, Pedersen C, Jensen CR, et al. The Cancer Patient's World- an Investigation of the Problems Experienced by Danish Cancer Patients. Copenhagen: Danish Cancer Society, 2006. [in Danish].
    1. Schmid-Buchi S, Halfens RJ, Dassen T, et al. Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. Eur J Oncol Nurs 2011;15:260–6
    1. Steele R, Fitch MI. Supportive care needs of patients with lung cancer. Can Oncol Nurs J 2010;20:15–22
    1. Steele R, Fitch MI. Supportive care needs of women with gynaecological cancer. Cancer Nurs 2008;31:284–91
    1. Armes J, Crowe M, Colbourne L, et al. Patients' supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol 2009;27:6172–9
    1. McDowell ME, Occhipinti S, Ferguson M, et al. Predictors of change in unmet supportive care needs in cancer. Psychooncology 2010;19:508–16
    1. World Health Organisation (accessed 18 Nov 2011).
    1. Jones R, Regan M, Ristevski E, et al. Patients' perception of communication with clinicians during screening and discussion of cancer supportive care needs. Patient Educ Couns 2011;85:e209–15
    1. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol 2006;24:5112–16
    1. Gilbert SM, Miller DC, Hollenbeck BK, et al. Cancer survivorship: challenges and changing paradigms. J Urol 2008;179:431–8
    1. Houlihan NG. Transitioning to cancer survivorship: plans of care. Oncology 2009;23(8 Suppl):42–8
    1. Olesen F, Dickinson J, Hjortdahl P. General practice—time for a new definition. BMJ 2000;320:354–7
    1. Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr 2010;2010:25–30
    1. Smith SM, Allwright S, O'Dowd T. Does sharing care across the primary-specialty interface improve outcomes in chronic disease? A systematic review. Am J Manag Care 2008;14:213–24
    1. Nielsen JD, Palshof T, Mainz J, et al. Randomised controlled trial of a shared care programme for newly referred cancer patients: bridging the gap between general practice and hospital. Qual Saf Health Care 2003;12:263–72
    1. Grunfeld E. Primary care physicians and oncologists are players on the same team. J Clin Oncol 2008;26:2246–7
    1. Grunfeld E. Cancer survivorship: a challenge for primary care physicians. Br J Gen Pract 2005;55:741–2
    1. Johansson B, Berglund G, Hoffman K, et al. The role of the general practitioner in cancer care and the effect of an extended information routine. Scand J Prim Health Care 2000;18:143–8
    1. Kendall M, Boyd K, Campbell C, et al. How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers. Fam Pract 2006;23:644–50
    1. Anvik T, Holtedahl KA, Mikalsen H. “When patients have cancer, they stop seeing me”–the role of the general practitioner in early follow-up of patients with cancer–a qualitative study. BMC Fam Pract 2006;7:19.
    1. Bulsara C, Ward AM, Joske D. Patient perceptions of the GP role in cancer management. Aust Fam Physician 2005;34:299–300, 302.
    1. Mikkelsen TH. PhD-thesis: Cancer rehabilitation in Denmark—With Particular Focus on the Present and Future Role of General Practice. Denmark: Faculty of Health Sciences, University of Aarhus, 2009. ISBN 978-87-90004-09-5.
    1. Hansen DG, Bergholdt SH, Holm L, et al. A complex intervention to enhance the involvement of general practitioners in cancer rehabilitation. Protocol for a randomised controlled trial and feasibility study of a multimodal intervention. Acta Oncol 2011;50:299–306
    1. 2009
    1. PLO Praksistælling [General Practitioners' Organisation Practice Count]. Copenhagen: PLO [General Practitioners' Organisation], 2009
    1. Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ 1996;30:83–9
    1. Mikkelsen T, Sondergaard J, Sokolowski I, et al. Cancer survivors' rehabilitation needs in a primary health care context. Fam Pract 2009;26:221–30
    1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76
    1. Groenvold M, Klee MC, Sprangers MA, et al. Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 1997;50:441–50
    1. Baker F, Denniston M, Zabora J, et al. A POMS short form for cancer patients: psychometric and structural evaluation. Psycho-Oncology 2002;11:273–81
    1. Scott NW, Fayers PM, Aaronson NK, et al. EORTC QLQ-C30 Reference Values Manual. EORTC Quality of Life Group. Brussels: EORTC, 2008
    1. Cocks K, King MT, Velikova G, et al. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. J Clin Oncol 2010;29;89–96
    1. Holtedahl K, Norum J, Anvik T, et al. Do cancer patients benefit from short-term contact with a general practitioner following cancer treatment? A randomised, controlled study. Support Care Cancer 2005;13:949–56
    1. Johansson B, Brandberg Y, Hellbom M, et al. Health-related quality of life and distress in cancer patients: results from a large randomised study. Br J Cancer 2008;99:1975–83
    1. Lewis RA, Neal RD, Williams NH, et al. Follow-up of cancer in primary care versus secondary care: systematic review. Br J Gen Pract 2009;59:e234–47
    1. Aranda S, Schofield P, Weih L, et al. Meeting the support and information needs of women with advanced breast cancer: a randomised controlled trial. Br J Cancer 2006;95:667–73
    1. Rottmann N, Dalton SO, Bidstrup PE, et al. No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial. Psychooncology. Published Online First: 8 February 2011. doi:
    1. Ross L, Boesen EH, Dalton SO, et al. Mind and cancer: does psychosocial intervention improve survival and psychological well-being? Eur J Cancer 2002;38;1447–57
    1. Fors EA, Bertheussen GF, Thune I, et al. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology 2010;20:909–18
    1. Newell SA, Sanson-Fisher RW, Savolainen NJ. Systematic review of psychological therapies for cancer Patients: overview and recommendations for future research. J Natl Cancer Inst 2002;94:558–84
    1. Uitterhoeve RJ, Vernooy M, Litjens M, et al. Psychosocial interventions for patients with advanced cancer—a systematic review of the literature. Br J Cancer 2004;91:1050–62

Source: PubMed

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