The British journal of surgery · 2026
Patient-led, home-based follow-up for colorectal cancer: DISTANCE multicentre stepped-wedge cluster randomised trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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van Driel M H Elise, Swartjes Hidde, Lemmens Jobbe M G, Qaderi Seyed M, Teerenstra Steven, Custers Jose A E, Elferink Marloes A G, van Wely Bob J, Bloemen Johanne G, van Grevenstein Wilhelmina M U, van Duijvendijk Peter, Verdaasdonk Emiel G G, de Roos Marnix A J, Coupé Veerle M H, Vink Geraldine R, Verhoef Cornelis, Grünhagen Dirk J, de Wilt Johannes H W
Аннотация
BACKGROUND: Colorectal cancer (CRC) incidence is rising; consequently, traditional follow-up care models are increasingly unsustainable. Patient-led, home-based follow-up (PHFU) may offer a promising alternative to reduce hospital visits while maintaining patient well-being.
METHODS: The DISTANCE trial was a stepped-wedge cluster randomised trial conducted in six hospitals in the Netherlands. A total of 354 stage I-III CRC survivors, disease-free at 12 months after surgery, were assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (assessed using the European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire (EORTC QLQ-C30); version 3.0), cancer-related worry (assessed using the Cancer Worry Scale (CWS)), and psychological distress (assessed using the Hospital Anxiety and Depression Scale (HADS)).
RESULTS: In the intention-to-treat (ITT) analysis, no significant difference in hospital contacts was observed. In the as-treated (AT) analysis, PHFU reduced hospital contacts by 38% compared with standard follow-up (rate ratio 0.62 (95% c.i. 0.51 to 0.75), P < 0.001). There was substantial crossover, with 117 patients assigned to PHFU receiving standard follow-up and 10 patients assigned to standard follow-up receiving PHFU. No significant differences between the two groups were found with regard to quality of life or psychological well-being.
CONCLUSION: The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.
METHODS: The DISTANCE trial was a stepped-wedge cluster randomised trial conducted in six hospitals in the Netherlands. A total of 354 stage I-III CRC survivors, disease-free at 12 months after surgery, were assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (assessed using the European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire (EORTC QLQ-C30); version 3.0), cancer-related worry (assessed using the Cancer Worry Scale (CWS)), and psychological distress (assessed using the Hospital Anxiety and Depression Scale (HADS)).
RESULTS: In the intention-to-treat (ITT) analysis, no significant difference in hospital contacts was observed. In the as-treated (AT) analysis, PHFU reduced hospital contacts by 38% compared with standard follow-up (rate ratio 0.62 (95% c.i. 0.51 to 0.75), P < 0.001). There was substantial crossover, with 117 patients assigned to PHFU receiving standard follow-up and 10 patients assigned to standard follow-up receiving PHFU. No significant differences between the two groups were found with regard to quality of life or psychological well-being.
CONCLUSION: The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.