SCORE: A multisite randomised controlled trial evaluating shared care for colorectal cancer survivors.

Authors

Michael Jefford

Michael Jefford

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Michael Jefford , Jon D. Emery , Andrew James Martin , Richard De Abreu Lourenço , Karolina Lisy , Mustafa Abdi Mohamed , Dorothy King , Niall C. Tebbutt , Margaret Lee , Ashkan Mehrnejad , Adele Burgess , Julie Marker , Renee Eggins , Joseph Carrello , Hayley Thomas , Penelope Schofield

Organizations

Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia, Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Peter MacCallum Cancer Centre, Melbourne, Australia, Department of Medical Oncology, Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia, Eastern Health, Western Health, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia, Austin Health, Melbourne, Australia, Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, Australia, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, University of Technology Sydney, Sydney, Australia, NHMRC Clinical Trials Centre, Sydney, Australia, Swinburne University of Technology, Melbourne, Australia

Research Funding

Other
Victorian Cancer Agency and Cancer Australia

Background: Few studies have considered shared follow up (FU) care (SC) between oncologists and primary care providers (PCPs). SCORE is the first large RCT of SC for survivors of colorectal cancer (CRC). Primary objective: compare SC vs UC on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months (mo). Secondary objectives: compare SC vs UC on QoL; patient (pt) perceptions of care; costs and clinical care processes (CEA tests, recurrences). Methods: Pts had completed treatment for stage I-III CRC within 3 mo, had a PCP, and no prior cancer. After pt consent, PCPs could opt out. SC replaced 2 routine oncologist visits with PCP visits and included a survivorship care plan, concerns checklist and PCP management guidelines. PCPs were asked to request CEA tests at 3 and 9 mo visits. Assessments were at baseline (BL), 6 and 12 mo FU. Difference (diff) between groups on GHQ-QoL to 12 mo estimated from a mixed model for repeated measures (MMRM). Non-inferiority evaluated by comparing the lower limit of the two-sided 95% confidence interval (CI) for the estimated diff (SC–UC) against a non-inferiority margin (NIM) of -10 points. Per-protocol population (PPP) comprised all randomised pts with ≥ 1 post-BL questionnaire (6 +/or 12mo) and, for SC, ≥ 1 of the PCP visits. Results: 150 pts were randomised to SC (N=74) or UC (N=76); 11 PCPs had declined. Median age 63 years, 39% women, 24% had radiation. Primary site: colon (59%), rectum (32%), overlapping (9%). 138/150 (92%) had BL and ≥ 1 post-BL GHQ-QoL score. 65/74 (88%) of SC pts attended 3- and/or 9-mo PCP visits. The mean (SD) GHQ-QoL scores at baseline / 6 mo / 12 mo were: 69 (18.7) / 69 (21.2) / 72 (20.2) for SC versus 68 (20.0) / 73 (15.1) / 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 mo and 12 mo FU was 69 for SC and 73 for UC, mean diff -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. For the PPP (N=130/150), mean diff was -5.0 (95% CI: -10.1 to 0.2). No clear evidence of between group differences on other QoL, unmet needs or satisfaction scales (C30, CR29, SUNS, PSQ), accounting for multiplicity. At 12 mo, more patients in SC (40/62, 65%) vs UC (24/58, 41%) felt their PCP was sufficiently knowledgeable (AOPSS). At 12 mo, most popular preferences for FU were: SC for 40/63 (63%) in the SC group; similar preferences for SC 22/62 (35%) and ‘Hospital-based care with the doctors that treated the cancer’ 22/62 (35%) in UC. CEA completion was 89% at 3 mo and 83% at 9 mo in SC; 63% and 68% in UC. 5 recurrences in SC and 6 in UC arms. Pts in SC on average incurred A$456 less in health costs vs UC pts. Conclusions: SCORE had high PCP participation and pt retention. Compared to UC, pts having SC had non-inferior QoL, and lower costs. Adherence to CEA testing was higher in SC. Pts exposed to SC prefer this model of FU. Clinical trial information: ACTRN12617000004369.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Oral Abstract Session

Session Title

Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Clinical Trial Registration Number

ACTRN12617000004369

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 1505)

DOI

10.1200/JCO.2023.41.16_suppl.1505

Abstract #

1505

Abstract Disclosures

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