Effectiveness of a guided online primary care intervention for fear of cancer recurrence:A randomised controlled trial

ObjectiveFear of Cancer Recurrence (FCR) is highly prevalent among cancer survivors and leads to decreased quality of life and increased healthcare costs. We assessed the effectiveness of a guided online primary care intervention for FCR, compared to waiting list. MethodsIn this RCT, participants were recruited online and randomised 1:1. All adults who finished successful curative cancer treatment between 3 months and 10 years ago, wanted support for FCR, and had sufficient Dutch skills were eligible. The intervention consisted of a 10‐week online programme and three to five video calling sessions with a trained mental health worker. After 6 months, the control group received the same intervention. The primary outcome was the difference between the groups in the change in FCR severity from baseline (T0) to 6 months (T2), measured online with the short form of the Fear of Cancer Recurrence Inventory. ResultsOne hundred and seventy‐three participants were enroled and randomised to the intervention (n = 86) or control group (n = 87). FCR severity dropped 2.1 points more in the intervention group than in the control group (2.7 points (SD = 3.9) versus 0.6 points (SD = 3.6), t(154) = 3.4, p = 0.0007). General mental well‐being also improved significantly in the intervention group and remained stable in the control group. These improvements remained at 10 months follow up.ConclusionsThis easily accessible and relatively inexpensive intervention effectively reduces FCR and has potential to replace or precede existing more intensive psychological treatments, improving patients' access to care. Trial registrationThe trial was prospectively registered in the Netherlands Trial Register on 25‐02‐2019 with number NL757

Need for a primary care based intervention for fear of cancer recurrence:Conclusions from the blanket trial

Background More than half of cancer survivors experience fear of cancer recurrence (FCR). There has been a call for easily accessible, inexpensive interventions for moderate FCR to complement existing specialized care. In the randomized BLANKET trial, we investigated the effectiveness of a short, primary care intervention for FCR. We report on the potential of the intervention and the suitability of primary care to offer this intervention. Methods The BLANKET trial is a cluster randomized controlled trial with change in FCR severity (severity subscale of the Fear of Cancer Recurrence Inventory) as its main outcome. Participating general practitioners invited all patients who completed successful curative cancer treatment between 3 months and 10 years ago. We report effect measures, outcome of our recruitment strategy, intervention uptake, reasons not to participate, and experiences with the intervention. Results Sixty-two of 1368 (4.5%) invited cancer survivors participated. Main reported reasons not to participate were not experiencing FCR and not wanting help. Owing to the low participation, we could not robustly evaluate the intervention's effectiveness. Indicatively, in the intention-to-treat analysis, FCR severity decreased from T0 to T1 by 2.7 points (standard deviation [SD] = 4.7) in the intervention group (n = 27) and 1.8 points (SD = 3.6) in the control group (n = 18). In the per-protocol analysis, the decreases were 3.5 points (SD = 4.5) and 0.7 points (SD = 2.7), respectively. Conclusion Although the prevalence of FCR and the need for help for FCR are high according to the literature, the uptake of our primary care–based intervention was low. Although the intervention shows potential, alternative delivery routes need to be explored because of the low number of patients who need help for FCR per primary care practice. We recommend additional research on the impact of FCR, on which patients require and desire help, and on what kind of intervention and setting are fitting for what patients

Shared decision making in cancer treatment: a Dutch national survey on patients' preferences and perceptions

Objective: Shared decision making (SDM) for cancer treatment yields positive results. However, it appears that discussing essential topics for SDM is not fully integrated into treatment decision making yet. Therefore, we aim to explore to what extent discussion of therapy options, treatment consequences, and personal priorities is preferred and perceived by (former) cancer patients.Methods: An online questionnaire was distributed by the Dutch Federation of Cancer Patient Organisations among (former) cancer patients in 2018.Results: Among 3785 (former) cancer patients, 3254 patients (86%) had discussed treatments with their health care provider (HCP) and were included for analysis. Mean age was 62.1 +/- 11.5; 55% were female. Discussing the option to choose no (further) treatment was rated by 2751 (84.5%) as very important (median score 9/10-IQR 8-10). Its occurrence was perceived by 28% (N = 899), and short- and long-term treatment consequences were discussed in 81% (N = 2626) and 53% (N = 1727), respectively. An unmet wish to discuss short- and long-term consequences was reported by 22% and 26%, respectively. Less than half of the (former) cancer patients perceived that personal priorities (44%) and future plans (34%) were discussed.Conclusion: In the perception of (former) cancer patients, several essential elements for effective SDM are insufficiently discussed during cancer treatment decision making.Analysis and support of clinical decision makin

What is the prevalence of fear of cancer recurrence in cancer survivors and patients?:A systematic review and individual participant data meta-analysis

OBJECTIVE: Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. METHODS: This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0-36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. CONCLUSIONS: FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185)

Case finding strategies for hepatitis C infection

Hepatitis C virus infection (HCV) is a viral liver disease affecting approximately 3% of the world’s population and 0.1 to 0.4% of the population of the Netherlands. HCV infection can lead to liver cirrhosis and liver cancer. In addition to the severe burden of disease, the failure to find and treat those infected at an early stage also leads to a considerable economic burden on society. Since treatment success rates have improved substantially in the past years, long term complications can now be largely prevented. Consequently, the need for finding and treating those infected with HCV is on the increase. This thesis aims to improve case finding by evaluating the effectiveness and the economic consequences of a variety of case finding strategies for hepatitis C. Chapter 1 provides an overview of why improvements in case finding of hepatitis C are important. Chapter 2 demonstrates that increased efforts in case finding strategies to reach the target population and medical professionals are worth the effort. Section 2.1 shows that a public campaign aimed at increasing awareness and case finding of HCV in the general population can be effective, but only with a supplementary support programme for primary care. In Section 2.2 we conclude that in a campaign aimed at HCV case finding among injecting and non-injecting hard drug users, pro-actively offering HCV consultation and testing by professionals in addiction care organisations is essential to attain effect. Chapter 3 illuminates the economic side of HCV case finding. Section 3.1 demonstrates that if a case finding strategy is found to be clearly effective it is also likely to be cost-effective. For high-risk populations such as hard drug users the gain in effect is relatively high and costs of case finding can be kept low. In Section 3.2 the current costs of HCV treatment in daily practice in the Netherlands, in relation to treatment outcome and side effects, are discussed. Although success rates have improved substantially in the past decades, the current costs of unsuccessful treatment and side effects are high. Section 3.3 shows the effectiveness and cost-effectiveness of a nationwide hepatitis C campaign and its interventions in the Netherlands. The intervention aimed at hard drug users in addiction care was clearly effective and cost-effective. The intervention aimed at risk groups in the general population showed only a moderate effect, leading to considerable uncertainty about cost-effectiveness. This could in part be contributed to the unfavourable circumstances of its implementation. However, the overall number of HCV carriers identified by this large scale campaign remains moderate. Chapter 4 describes the effect of a new HCV case finding strategy in primary care practice. We demonstrate that routine testing for HCV in patients with an ALT elevation of 50 to 100IU/L could theoretically lead to the identification of an estimated 1,200 to 1,300 chronic HCV carriers in the Netherlands alone. The final chapter describes the lessons learned from the thesis and the role of different health care professionals in the identification of hepatitis C

Do GPs know their cancer patients? A linkage study using Electronic Medical Records (EMRs)

Prevention, Population and Disease management (PrePoD

Follow-up of mild alanine aminotransferase elevation identifies hidden hepatitis C in primary care

BACKGROUND: Hepatitis C (HCV) and hepatitis B (HBV) virus infection can lead to serious complications if left untreated, but often remain undetected in primary care. Mild alanine aminotransferase (ALT) elevations (30-100 IU/l) are commonly found and could be associated with viral hepatitis; unfortunately, these findings frequently remain without follow-up. AIM: To determine if and how mild ALT elevation can be used to identify hidden HCV and HBV infection in primary care. DESIGN AND SETTING: Primary care patients referred for liver enzyme testing were selected by a large primary care Diagnostic Centre (Saltro). METHOD: First, 750 anonymous samples were collected in three categories of ALT elevation (30-50 IU/l, 50-70 IU/l, and 70-100 IU/l) and tested for HCV and HBV. Second, the national prevalence of each ALT elevation was estimated by analysing all annual ALT tests performed at Saltro. RESULTS: HCV prevalence was 1.6% and 1.2% in patients with an ALT of 50-70 IU/l and 70-100 IU/l respectively. In patients with an ALT of 30-50 IU/l, HCV prevalence was normal (≤0.1%). HBV prevalence was normal (≤0.4%) in all groups. The estimated number of ALT tests performed nationally each year in primary care was 1.1 million. An ALT of 30-50 IU/l was found in 21.1%, an ALT of 50-70 IU/l in 5.6%, and 2.6% had an ALT of 70-100 IU/l. CONCLUSION: In primary care patients with an ALT level of 50-100 IU/l, HCV prevalence is tenfold the population prevalence, whereas HBV prevalence is not elevated. Therefore, diagnostic follow-up for HCV is indicated in these patients, even when other explanations for ALT elevation are present