Every year, 12,000 people are diagnosed with bowel cancer in the Netherlands
The Erasmus MC Cancer Institute will investigate whether ex-colon cancer patients enjoy having their follow-up check-ups at home. In the study they can also choose how often they want such a follow-up check-up and how they want to be informed about the results.
The study, conducted by oncological surgeons Dirk Grünhagen and Kees Verhoef, is co-financed by the KWF. At least 200 patients are being sought for the study who will be treated in the Erasmus MC, IJsselland Hospital in Capelle aan den IJssel or in the Amphia Hospital in Breda.
Five years
Every year, 12,000 people are diagnosed with bowel cancer in the Netherlands. About 90 percent of these patients can be operated on, with the aim of curing him or her. Yet in 30 percent of them metastases develop. Therefore, colon cancer patients are monitored for up to five years after their surgery.
‘All these people come to the hospital at least once, but often several times a year. They come for blood tests to check for the presence of tumor markers, for a CT scan and a meeting with the doctor’, says Dirk Grünhagen. ‘However, research has shown years ago that it makes no difference to survival whether you have a CT scan six, four or twice a year.’
Grünhagen wants to make one thing clear first: they continue to keep a close eye on their patients. As good as described in all oncological guidelines. ‘But the blood tests and conversations that are conducted in the hospital can also be done at home. The question is therefore whether all these people should come to the hospital if a CT scan does not have to be made. Do you have to do that to them?’
no cancer
By having people come to the hospital for five years, they continue to feel like patients for five years, says Grünhagen. ‘When essentially they don’t have cancer anymore. It was removed during the operation. We can imagine that patients then feel the need to move on with their lives and to choose for themselves how they want the follow-up check-ups.’
As described in the guideline, all participants will visit once a year after surgery for a CT scan. But they are given a choice in three other parts of the follow-up check. They can choose how often they want to undergo a follow-up check, as long as this is not less checks than indicated in the directive. That is a blood test once every six months.
Letting people come to the hospital for five years keeps them feeling like patients for five years
Then they can choose how they want their blood test: do it at home with a finger prick and send that blood to the hospital by post. They can have the injection done at the general practitioner or the doctor’s laboratory, or come to the hospital for the injection.
Finally, they can also choose how they want to hear the result. If there are no bad results to report, they can choose not to receive a call. They can also choose to always receive a phone call with the results. But they can also visit their doctor to hear the results.
Security
‘The control therefore rests entirely with the patient. There will be people who say: no news is good news. Finished. But if people need to talk to their doctor, that’s fine too. Some patients prefer to stay away from the hospital for as long as possible, while for others a conversation in the hospital offers a sense of security. The choice is entirely up to the patient.’
The ultimate goal of freedom of choice is to offer the patient the best possible quality of life, says Grünhagen. ‘We hope that patients will become happier, more satisfied and less anxious. But before we can determine whether freedom of choice contributes to this, we will have to measure this.’ The participants are therefore extensively questioned about their experiences in the second part of the study.
If some patients do indeed opt for follow-up check-ups at home, this does offer some advantages. ‘There is less traffic between the patient’s place of residence and the hospital, which is good for traffic and the environment. But the pressure on the outpatient clinics is also less.’
Smartwatch
In a few years’ time, the researchers want to link a third part to the study. They will see whether even better remote monitoring is possible with the help of technological innovation. Grünhagen: ‘With smartwatches and smartphones, doctors can already keep an eye on their patients, if they want to.’
Heart rate, sleep, movement, these are all things that wristwatches can register, without the patient having to do anything. ‘Tumor markers will also be found in urine in the foreseeable future’, continues Grünhagen. ‘Companies are already developing sensors that test urine for proteins in toilet bowls. It’s in the future, but it’s coming.’
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