A Randomized Controlled Trial of a Nurse-Led Supportive Care Package (SurvivorCare) for Survivors of Colorectal Cancer.
Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls.



At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care.



Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOL at FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items).



The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care.



Some survivors of colorectal cancer report distressing effects after completing treatment. Strategies to identify and respond to survivors' issues are needed. In a randomized controlled trial, the addition of a nurse-led supportive care package (SurvivorCare) to usual post-treatment care did not impact survivors' distress, quality of life, or unmet needs. However, patients receiving the SurvivorCare intervention were more satisfied with survivorship care. Factors for consideration in the design of subsequent studies are discussed.
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia Michael.Jefford@petermac.org.
Michael
M
Jefford
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Karla
K
Gough
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Allison
A
Drosdowsky
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Deakin University, Melbourne, Victoria, Australia.
Lahiru
L
Russell
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Cancer Institute NSW, Sydney, New South Wales, Australia.
Sanchia
S
Aranda
University of Sydney, Sydney, New South Wales, Australia.
Phyllis
P
Butow
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Jo
J
Phipps-Nelson
Cancer Institute NSW, Sydney, New South Wales, Australia University of Sydney, Sydney, New South Wales, Australia.
Jane
J
Young
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
Mei
M
Krishnasamy
Deakin University, Melbourne, Victoria, Australia.
Anna
A
Ugalde
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Dorothy
D
King
Monash Health, Melbourne, Victoria, Australia.
Andrew
A
Strickland
Monash Health, Melbourne, Victoria, Australia.
Michael
M
Franco
Bendigo Health, Bendigo, Victoria, Australia.
Robert
R
Blum
Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
Catherine
C
Johnson
Peninsula and Southeast Oncology, Melbourne, Victoria, Australia.
Vinod
V
Ganju
Cabrini Hospital, Melbourne, Victoria, Australia.
Jeremy
J
Shapiro
Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia.
Geoffrey
G
Chong
Newcastle Private Hospital, Newcastle, New South Wales, Australia.
Julie
J
Charlton
Alfred Health, Melbourne, Victoria, Australia.
Andrew
A
Haydon
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia.
Penelope
P
Schofield
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009726:Nurses / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology
Colorectal cancer; Distress; Nurse; Quality of life; Randomized controlled trial; Survivors