title: Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial.
abstract: OBJECTIVE
  To assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient's quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Northern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities.
  
  
  METHODS
  Patients surgically treated for colon cancer, hospital surgeons and community GPs.
  
  
  METHODS
  24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used.
  
  
  METHODS
  Primary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses.
  
  
  RESULTS
  110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ-2.23, p=0.20; EQ-5D index; Δ-0.10, p=0.48, EQ-5D VAS; Δ-1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001).
  
  
  CONCLUSIONS
  GP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT00572143.
authors.affiliation: Norwegian Center of Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Knut Magne
authors.initials: KM
authors.lastname: Augestad
authors.forename: Jan
authors.initials: J
authors.lastname: Norum
authors.forename: Stefan
authors.initials: S
authors.lastname: Dehof
authors.forename: Ranveig
authors.initials: R
authors.lastname: Aspevik
authors.forename: Unni
authors.initials: U
authors.lastname: Ringberg
authors.forename: Torunn
authors.initials: T
authors.lastname: Nestvold
authors.forename: Barthold
authors.initials: B
authors.lastname: Vonen
authors.forename: Stein Olav
authors.initials: SO
authors.lastname: Skrøvseth
authors.forename: Rolv-Ole
authors.initials: RO
authors.lastname: Lindsetmo
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