Patient-led, home-based follow-up for colorectal cancer: the DISTANCE multicentre stepped-wedge cluster-randomised trial
M H Elise van Driel, Hidde Swartjes, Jobbe M G Lemmens, Seyed M Qaderi, Steven Teerenstra, Jose A E Custers, Marloes A G Elferink, Bob J van Wely, Johanne G Bloemen, Wilhelmina M U van Grevenstein, Peter van Duijvendijk, Emiel G G Verdaasdonk, Marnix A J de Roos, Veerle M H Coupé, Geraldine R Vink, Cornelis Verhoef, Dirk J Grünhagen, Johannes H W de WiltAbstract
Introduction
Colorectal cancer (CRC) incidence is rising, consequentially 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 is 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 post-surgery, assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (QoL, EORTC QLQ-C30), cancer-related worry (CWS), and psychological distress (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 to standard follow-up (RR 0.62, 95% CI 0.51–0.75, 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 were found in QoL or psychological distress between the two groups.
Conclusion
The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.TOC Summary