title: Impact of shared care program in follow-up of childhood cancer survivors: An intervention study.
abstract: BACKGROUND
  With the growing rate of childhood cancer cure and the risks of sequelae, long-term follow-up (FU) of survivors is a central issue. Several models have been proven far from satisfactory. Shared care FU is the result of collaboration between general practitioners (GPs) and cancer centers. We sought to demonstrate the feasibility of setting up a shared care program based on the patient-centered education of GPs and to evaluate the impact of this model in an intervention study.
  
  
  METHODS
  We compared the FU care achievement in two childhood cancer survivor cohorts in the same pediatric oncology center, (i) control group (n = 134) and (ii) intervention study cohort (n = 137), after setting up the program.
  
  
  RESULTS
  The rate of survivors answering the survey and the rate of patients involved in FU by their GPs were higher in intervention study cohort than in baseline one (132/137 vs. 72/134 and 110/132 vs. 13/72; P ≤ 0.0001). The lack of any FU was definitely lower (10/132 vs. 18/72; P = 0.001) in the intervention study cohort.
  
  
  CONCLUSIONS
  In this shared care program, survivors overcame distrust in their GP's knowledge and entered the FU program after their GPs had been involved in patient-centered education. Personalized and incentive-based guidance was very useful in helping survivors to adhere to FU. Support of a dedicated long-term FU team was very useful. A nationwide organization, consideration of special needs in subgroups of survivors and sustained funding are needed to adjust the program in the very long term.
authors.affiliation: Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.|Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ducassou
authors.affiliation: General Practitioner, Bordeaux, France.
authors.forename: Maïté
authors.initials: M
authors.lastname: Chipi
authors.affiliation: General Practitioner, Bordeaux, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Pouyade
authors.affiliation: General Practitioner, Bordeaux, France.|Unit of General Medicine, Bordeaux University, Bordeaux, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Afonso
authors.affiliation: General Practitioner, Bordeaux, France.|Unit of General Medicine, Bordeaux University, Bordeaux, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Demeaux
authors.affiliation: General Practitioner, Bordeaux, France.|Unit of General Medicine, Bordeaux University, Bordeaux, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Ducos
authors.affiliation: Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.|Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Pérel
authors.affiliation: Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.|General Practitioner, Bordeaux, France.|Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ansoborlo
mesh_terms: D060866:Accountable Care Organizations; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate; D017741:Survivors
keywords: childhood cancer survivor; general practitioner; long-term outcome; shared care