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Patiënt symptomen, problemen en zorgbehoefte na behandeling voor coloncarcinoom

Explore patient symptoms, problems, and care needs post-colon cancer treatment to enhance future healthcare support by general practitioners. High symptom prevalence, varied assistance seeking behavior, and persistent care needs identified in a multicenter study. Findings utilized in ICARE protocol. Surgeon-led vs. GP-led follow-up care assessed in a randomized controlled trial. Contact T. Wieldraaijer for more information.

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Patiënt symptomen, problemen en zorgbehoefte na behandeling voor coloncarcinoom

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  1. Patiënt symptomen, problemen en zorgbehoefte na behandeling voor coloncarcinoom T. Wieldraaijer, L.A.M. Duineveld, K.M. van Asselt, H.C.P.M. van Weert, J. Wind Academisch Medisch Centrum Amsterdam, afdeling Huisartsgeneeskunde

  2. Introductie • 2020 verwacht 17.000 patiënten met colorectaal carcinoom • Toenemende incidentie • Verbeterde overleving • Momenteel chirurgische nacontroles • Veel symptomen niet adequaat behandeld • Patiënt symptomen en problemen onderzoeken om toekomstige nazorg door huisarts voor te bereiden. • Welke symptomen? Problemen? Hulp zoeken?

  3. Methoden • Multicenter prospectieve cohortstudie • Opeenvolgende patiënten met stadium I-III coloncarcinoom na OK • November 2013 – november 2014 • 6 ziekenhuizen • Studieperiode– 6 maanden • Vragenlijsten • Generiek (EORTC QLQ-C30) • Ziekte specifiek(EORTC QLQ-C29) • Participatie en autonomie specifiek • Lichamelijke activiteit

  4. Methoden

  5. Resultaten • Outpatient clinic visit • First visit after surgery • Planned follow-up Surgery or adjuvant therapy >6 months ago Only surgery, no adjuvant therapy Just completed adjuvant therapy Undergoing adjuvant therapy Group 1 Group 2 Group 3 Group 4 Inclusion into cohort N=287 N=77 N=50 N=36 N=124 • Data collection patient needs and healthcare use • Baseline questionnaire • Questionnaire after 2 months • Questionnaire after 6 months • Self-reported complaints 1 week per month • Self-reported healthcare use • CQ-index after 6 months (satisfaction) COHORT Stage I, II, III colon carcinoma after surgical resection

  6. * Tumour stage was defined using the TNM5 criteria

  7. Resultaten

  8. Resultaten

  9. Conclusies • Hoog percentage symptomen bij patiënten na coloncarcinoom • Lichamelijk – 36%. Psychisch– 39%. Sociaal – 26% • Een derde van deze symptomen als problematisch ervaren • Hulp zoeken hangt af van de klacht (lichamelijk vs psychosociaal) • Hoogste percentage voor hulp zoeken  Invaliderende lichamelijke klachten of alarmsymptomen • Stoma gerelateerde klachten vrijwel allemaal gemeld • Voor sommige alarmsymptomen wordt geen hulp gezocht! • Symptomen nemen af met de tijd, maar de behoefte aan hulp blijft • Deze bevindingen zijn geïmplementeerd in protocol ICARE RCT

  10. Surgeon-led follow-up GP-led follow-up Surgeon-led follow-up and usual aftercare “Usual care” Surgeon-led follow-up with patients using OncoCompass GP-led follow-up with patients using OncoCompass GP-led follow-up and usual aftercare RCT Stage I, II, III colon carcinoma after surgical resection Non-randomized patients preference group Inclusion into trial RANDOMIZATION

  11. Vragen Thijs Wieldraaijer t.wieldraaijer@amc.uva.nl

  12. Comorbidities Chronic disease The Netherlands Cancer Registry

  13. Questionnaires • Generic and disease specific quality of life questionnaires (EORTC QLQ-C30, EORTC QLQ-CR29) • Aaronson N, Ahmedzai KS, et al: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993 • Whistance RN, Conroy T, et al: Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009 Nov;45(17):3017-26. doi: 10.1016/j.ejca.2009.08.014. Epub 2009 Sep 16. • Participation and autonomy specific questionnaire (‘Impact on participation and autonomy’) • Cardol M, de Haan RJ, de Jong BA, van den Bos GA, de Groot IJ. Psychometric properties of the Impact on Participation and Autonomy Questionnaire. Arch Phys Med Rehabil. 2001 Feb;82(2):210-6. • Physical activity questionnaire (Short Questionnaire to Asses Health enhancing physical activity) • Wendel-Vos GCW, Schuit AJ, Saris WHM, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003;56:1163e9.

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