title: Substitution scenario in follow-up of chronic cancer patients in primary care: prevalence, disease duration and estimated extra consultation time.
abstract: BACKGROUND
  The incidence of cancer as well as survival rates for it are increasing. It is debated whether care in the chronic phase of cancer can be positioned in primary care due to doubts about capacity and workload.
  
  
  OBJECTIVE
  To estimate GPs' extra consultation time if they assume responsibility for the care in the chronic phase of cancer.
  
  
  METHODS
  Retrospective cohort study. Estimation of extra consultation time by quantifying prevalence, incidence, survival, number of chronic cancer patients, current practice contacts and registration of risk factors in patients with all types of cancers.
  
  
  RESULTS
  The most prevalent types of cancer (with 5-year survival rates) are as follows: breast cancer (91.5%), colorectal cancer (63.8%), prostate cancer (78.3%), melanoma (91.9%) and bladder and urinary tract cancer (77.3%). Primary care practices include ~32 chronic cancer patients, with a potential extra consultation time of ~19 hours per year per 1000 patients. One-third (35%) are already in a chronic disease management programme and 57% were diagnosed >5 years ago. Registration of risk factors for cancer is incomplete, but of better quality when comorbidity is present.
  
  
  CONCLUSIONS
  Numbers of chronic cancer patients and possible time investment by primary care professionals in the case of a substitution scenario should not be a limiting factor for transition of follow-up from secondary to primary care, as most of the patients were diagnosed >5 years ago and a large proportion of these patients are already monitored in an existing chronic care programme.
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands. Carola.vanDipten@radboudumc.nl.
authors.forename: C
authors.initials: C
authors.lastname: van Dipten
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: T C
authors.initials: TC
authors.lastname: Olde Hartman
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M C J
authors.initials: MC
authors.lastname: Biermans
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: W J J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D002908:Chronic Disease; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016526:Workload
keywords: Aftercare; electronic medical records; epidemiology; general practice; neoplasms; workload.