Randomized controlled trial of shared care for patients with cancer involving general practitioners and cancer specialists
Johnson CE., Saunders CM., Phillips M., Emery JD., Nowak AK., Overheu K., Ward AM., Joske DJL.
Copyright © 2015 by American Society of Clinical Oncology. Purpose: We aimed to determine whether a shared care model (SCM) during chemotherapy treatment improved emotional wellbeing, empowerment, and prevalence of symptoms for people being treated for cancer. Methods: People receiving chemotherapy for hematologic, breast, ovarian, or colorectal malignancies at two cancer centers were randomly assigned to receive SCM or standard care. The SCM involved a patient-held record, a project coordinator, routine contact between the patient and general practitioner/primary care physician, and primary care physician education. Participants completed the Hospital Anxiety and Depression Scale, the Mini-Mental Adjustment to Cancer, and an empowerment questionnaire before, in the middle of, and on completion of chemotherapy. The presence and severity of adverse effects of chemotherapy were recorded by patients in a symptom diary. Results: Ninety-seven eligible participants were randomly allocated, less than half the intended recruitment. There were no significant differences between the groups for empowerment, symptom prevalence, or Mini-Mental Adjustment to Cancer scores. The proportion with clinical anxiety (Hospital Anxiety and Depression Scale anxiety score of ≥ 11) decreased over time in both groups (P=.013) but decreased more in the intervention group (P=.002). Depression was unchanged over time. Conclusion: Our study was limited by low recruitment and predominance of patients with breast cancer, and was underpowered for the main analyses. Results should therefore be interpreted with caution. Little benefit was seen for SCM in the majority of domains including empowerment, symptom prevalence, and psychologic al adjustment to cancer. The SCM showed efficacy in clinically anxious patients. Such interventions may be better implemented by using a targeted approach to identify at-need subgroups.