Shared care just as effective as hospital-based care: SCORE trial

A Peter Mac-led study has found sharing follow-up care between a GP and hospital-based specialists was preferred by bowel cancer patients, was cheaper for the healthcare system and was just as effective as standard hospital-based care.

The SCORE (Shared Care follow-up for colOREctal cancer survivors) trial enrolled 150 patients who had just completed their bowel cancer treatment — involving surgery and, for most, also chemotherapy and radiotherapy — at Peter Mac or four other hospitals across Melbourne.

The trial claims to be the largest study of shared care follow-up for cancer survivors, and the only study of shared care for people who have been treated for bowel cancer.

For their follow-up appointments every three months, patients were randomised to have these either with hospital-based specialists (the current standard of care) or following a model where alternate visits were with the patient’s usual GP.

Professor Michael Jefford said the results supported a wider rollout of shared care — a model used for managing pregnant women and people with asthma, diabetes and heart disease in the community, but not for recovery from cancer.

“Our study shows that shared care is acceptable, safe, preferred by bowel cancer patients, and is cheaper for the healthcare system. We now need to focus on widespread implementation of this effective model,” said Jefford, who led the study and is an oncologist and Director of the Australian Cancer Survivorship Centre at Peter Mac.

Patients and GPs in the shared care arm received information about the post-treatment phase, and GPs received brief management guidelines.

GPs were more likely to do recommended tests, while Medicare data showed that shared care was cheaper. Patients who received shared care had a strong preference for this model, while those who received hospital-based care had an equal preference for either.

The ‘quality of life’ of patients was the same regardless of shared or hospital-based care, meeting the aim of the trial. Patient satisfaction and unmet needs were similar, and there was also no difference in cancer recurrence.

Jefford said the trial “responds to recommendations to investigate shared care models for cancer survivors”, noting the recent Australian Cancer Plan highlighted this as a potential response to cost and capacity constraints.

Findings have been published online in eClinicalMedicine and were previously presented at the annual meeting of the American Society of Clinical Oncology, held in Chicago in June.

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