Carriene Roorda

Increased primary health care use in the first year after colorectal cancer diagnosis.

Abstract Objective. The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). Design. Historical prospective study, using primary care data from two cohorts. Setting. Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30 000 patients. Subjects. Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). Main outcome measures. Primary healthcare use in the period 1998–2009. Findings. Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23–92%) more face-to-face contacts, 68% (range 36–108%) more drug prescriptions, and 35% (range –4–90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. Conclusions. The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services.

Model of care for women at increased risk of breast and ovarian cancer

Women with a family history of breast and/or ovarian cancer ave a substantially higher risk of developing these cancers and at much younger age when compared to the general population [1]. or women with a proven BRCA1 or BRCA2 mutation, this life time isk can reach up to 65% for breast cancer and up to 45% for ovarian ancer by the age of 70, according to two large meta-analyses [2,3]. In The Netherlands, the care for these high risk women is mainly oncentrated in university hospitals because of the availability of ighly specialized expertise. Our university hospital is situated in he North of The Netherlands, covering an area of 3.4 million inhabtants. In our hospital, the care for these women is provided by multidisciplinary team consisting of clinical geneticists, surgical ncologists, gynecological oncologists, oncology nurses, a psycholgist, a radiologist, plastic surgeons, and a pathologist. The team is upported by two epidemiologists. Interventions comprise a four-stage approach consisting of risk ssessment and genetic counselling, gene-mutation analysis, oncoogic counselling and medical screening or intervention strategies preventive surgery) [4]. When an increased cancer risk is assumed ecause of a personal or family history, women are referred to our amily cancer clinic [5,6]. The clinical geneticists assess the breast nd/or ovarian cancer risk based on a confirmation of the famly history, and whether there is an indication for DNA-testing. he women are extensively counselled on the pros and cons of NA-testing, its timing and the possible personal and familial conequences. If women need support with their decision making, they re referred to the psychologist of the team. The surgical oncologists counsel patients in their choice of isk reducing strategies. Regarding breast cancer, they can opt or screening or for a preventive mastectomy with or without econstructive surgery [7,8]. The latter service is provided by the lastic surgeons. All women opting for preventive mastectomy are eferred to the psychologist to discuss this option and the conseuences. Regarding ovarian cancer, women with a positive family history r a BRCA1/2 mutation are counselled by a gynecological oncolgist on risk reducing strategies for ovarian cancer. Women are ounselled on lifestyle, family planning and on the optimal timng of risk-reducing salpingo-oophorectomy (RRSO) and the shortnd long-term sequellae [9–11]. Since ovarian cancer screening is ot effective, from 2009 this option is not offered anymore. After RSO, women visit the family cancer clinic for advice regarding preention or treatment of hot flushes, psychosexual functioning and steoporosis [12–14]. By offering the care for these women in such an integrated way, he university hospital can take the lead as initiating participant

Do breast cancer survivors visit their General Practitioner for psychological problems? Reply to: Heins et al.: For which health problems do cancer survivors visit their General Practitioner?

With keen interest we read the recent article of Heins et al. published in the European Journal of Cancer. The authors examined reasons for increased primary health care use among patients with breast, prostate and colorectal cancer 2–5 years after diagnosis, when compared to non-cancer controls. They concluded that primary health care use in cancer survivors is mainly higher for common acute symptoms, such as back or abdominal pain and common infections. Furthermore, they concluded that the number of General Practitioner (GP) contacts related to psychosocial problems is also slightly increased in cancer survivors, but is not a major cause for the increase in health care use. However, breast cancer patients had more contacts with the GP for sleep problems and depression than controls. In a recently published study, we observed increased primary health care utilisation among breast cancer survivors. Just as in the study of Heins et al. diseases and symptoms were coded using the ICPC-I (International Classification of Primary Care). As GPs might have

Controle na borstkanker: voorkeuren van patiënten

SamenvattingRoorda-Lukkien C, De Bock GH, Scholing C, Van der Meer K, Berger MY, De Fouw M, et al. Controle na borstkanker: voorkeuren van patiënten. Huisarts Wet 2015;58(8):417-9.AchtergrondUit onderzoek blijkt dat vrouwen met borstkanker specialistische nacontrole prefereren boven nacontrole door de huisarts. Door middel van een kwalitatief onderzoek wilden wij de voorkeuren van Nederlandse vrouwen met borstkanker wat betreft nacontrole in de eerste lijn versus de tweede lijn verder uitdiepen.MethodeMet zeventig patiënten van het Registratie Netwerk Groningen hielden wij semigestructureerde interviews. Daarvoor maakten wij gebruik van een interviewleidraad. We hebben de interviews opgenomen en verbatim getranscribeerd. Twee onderzoekers hebben vervolgens onafhankelijk van elkaar een kwalitatieve en kwantitatieve inhoudsanalyse op de transcripten uitgevoerd. We hebben verschillen in codering tussen de onderzoekers besproken, totdat we consensus bereikten.ResultatenDe meerderheid van de patiënten (43/56) had een voorkeur voor specialistische nacontrole, vergeleken met andere vormen van nacontrole. Meer dan de helft (39/68) zou nacontrole in de huisartsenpraktijk accepteren, onder de voorwaarden van goede communicatie tussen huisarts en specialist en voldoende kennis bij huisartsen over nacontrole. Patiënten noemden zowel voordelen als belemmeringen ten aanzien van de nacontrole in de eerste lijn. Voordelen waren: de persoonlijke aard van de huisartspatiëntrelatie en de toegankelijkheid van de huisartsenpraktijk. Belemmeringen waren: beperkte kennis en vaardigheden, tijd en motivatie van huisartsen. Een andere belemmering betrof het vertrouwen van patiënten in de specialistische nacontrole.ConclusieMeer dan de helft van de patiënten stond open voor nacontrole in de eerste lijn. Mogelijk kan het vertrouwen in nacontrole door de huisarts toenemen als de communicatie tussen de eerste en tweede lijn verbetert en de kennis en vaardigheden van huisartsen worden vergroot door goede instructie en training.