Detection of colon cancer recurrences during follow-up care by general practitioners versus surgeons
Menée sur 303 patients atteints d'un cancer du côlon (67 % d'hommes ; âge moyen : 68 ans), cette étude compare les taux de détection d'une récidive, les délais avant détection et la mortalité en fonction du praticien qui effectue le suivi médical (généraliste ou chirurgien)
Background : In the I CARE study, colon cancer patients were randomized to receive follow-up care from either general practitioner (GP) or surgeon. Here, we address a secondary outcome, namely detection of recurrences, and effect on time to detection of transferring care from surgeon to GP.
Methods : Pattern, stage and treatment of recurrences were described after 3 years. Time to event was defined as date of surgery, until date of recurrence or last follow-up, with death as competing event. Effects on time to recurrence and death were estimated as hazard ratios (HRs) using Cox regression. Restricted mean survival times were estimated.
Results : Of 303 patients, 141 were randomized to the GP and 162 to the surgeon. Patients were male (67%) with a mean age of 68.0 years (SD 8.4). During follow-up, 46 recurrences were detected; 18 in the GP (13%) versus 28 in the surgeon group (17%). Most recurrences were detected via abnormal follow-up tests (74%) and treated with curative intent (59%). HR for recurrence was 0.75 [95% CI 0.41-1.36] in GP versus surgeon group. Patients in the GP group remained in the disease-free state slightly longer (2.76 versus 2.71 years). 38 patients died during follow-up; 15 in the GP (11%) versus 23 in the surgeon group (14%). 21 deaths (55%) were related to colon cancer. There were no differences in overall deaths between the groups (HR 0.76 [95% CI 0.39-1.46]).
Conclusion : Follow-up provided by GPs versus surgeons leads to similar detection of recurrences. Also, no differences in mortality were found.
Journal of the National Cancer Institute , article en libre accès, 2022