SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer.

Jefford, M; Emery, JD; James Martin, A; De Abreu Lourenco, R; Lisy, K; Grunfeld, E; Mohamed, MA; King, D; Tebbutt, NC; Lee, M; Mehrnejad, A; Burgess, A; Marker, J; Eggins, R; Carrello, J; Thomas, H; Schofield, P

SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer.

Jefford, M Emery, JD James Martin, A De Abreu Lourenco, R

Lisy, K Grunfeld, E Mohamed, MA King, D Tebbutt, NC Lee, M Mehrnejad, A Burgess, A Marker, J Eggins, R Carrello, J

Thomas, H Schofield, P

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Publisher:: ELSEVIER
Publication Type:: Journal Article
Citation:: EClinicalMedicine, 2023, 66, pp. 102346
Issue Date:: 2023-12

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Field	Value	Language
dc.contributor.author	Jefford, M
dc.contributor.author	Emery, JD
dc.contributor.author	James Martin, A
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.contributor.author	Lisy, K
dc.contributor.author	Grunfeld, E
dc.contributor.author	Mohamed, MA
dc.contributor.author	King, D
dc.contributor.author	Tebbutt, NC
dc.contributor.author	Lee, M
dc.contributor.author	Mehrnejad, A
dc.contributor.author	Burgess, A
dc.contributor.author	Marker, J
dc.contributor.author	Eggins, R
dc.contributor.author	Carrello, J https://orcid.org/0000-0001-6423-6555
dc.contributor.author	Thomas, H
dc.contributor.author	Schofield, P
dc.date.accessioned	2024-01-19T03:48:41Z
dc.date.available	2023-11-15
dc.date.available	2024-01-19T03:48:41Z
dc.date.issued	2023-12
dc.identifier.citation	EClinicalMedicine, 2023, 66, pp. 102346
dc.identifier.issn	2589-5370
dc.identifier.issn	2589-5370
dc.identifier.uri	http://hdl.handle.net/10453/174799
dc.description.abstract	BACKGROUND: SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. METHODS: The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. FINDINGS: 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. INTERPRETATION: SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. FUNDING: Victorian Cancer Agency and Cancer Australia.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	ELSEVIER
dc.relation.ispartof	EClinicalMedicine
dc.relation.isbasedon	10.1016/j.eclinm.2023.102346
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3202 Clinical sciences
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4206 Public health
dc.title	SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer.
dc.type	Journal Article
utslib.citation.volume	66
utslib.location.activity	England
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access	*
dc.date.updated	2024-01-19T03:48:40Z
pubs.publication-status	Published online
pubs.volume	66

Abstract:

BACKGROUND: SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. METHODS: The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I-III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of -10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. FINDINGS: 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. INTERPRETATION: SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. FUNDING: Victorian Cancer Agency and Cancer Australia.

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