Introduction
Men with prostate cancer require long term follow-up to monitor disease progression and manage common adverse physical and psychosocial consequences of treatment. There is growing recognition of the potential role of primary care in cancer follow-up. No previous trials have tested a model of shared care for prostate cancer.
Methods
The intervention was a shared care model of follow-up visits in the first 12 months after completing treatment for prostate cancer with the following components: a survivorship care plan, GP management guidelines, register and recall systems, screening for distress and unmet needs and patient information resources. Eligible men had completed surgery and/or radiotherapy for low-moderate risk prostate cancer within the previous eight weeks and had a GP who consented to participate. Men were randomised to the intervention or current hospital follow-up care. Study outcome measures collected at baseline, 3, 6 and 12 months included anxiety, depression, unmet needs, prostate cancer-specific quality of life (PCSQoL) and satisfaction with care. Clinical processes and health care resource usage were measured.
Results
Eighty-eight men were randomised (56% of eligible men approached), 45 to shared care; 85 were followed-up at 12 months. 91% of GPs agreed to participate. There were no differences between groups in anxiety, depression or PCSQoL at any time point, although scores of distress were low throughout. The two recurrences which occurred in the shared care arm were referred to specialist care within 1 week. At completion men in the shared care arm were significantly more likely than those receiving usual care to choose shared or primary care led care as their preferred model of follow-up (74% vs 41%). Health economic analyses are in progress.
Conclusions
Shared care of prostate cancer is feasible and shows no sign of significant harms. Following direct experience men prefer this model of care.