Follow-up care after treatment for gynecological cancer: can it be scaled down?
During the COVID-19 pandemic, care for patients with gynecological cancer was adjusted and scaled down.
Aim
This project aimed to assess the value of alternative forms of follow-up care after treatment for gynecological cancer. The focus was on patient experiences, healthcare utilization, costs, and oncological outcomes (such as recurrence-free survival and overall survival).
Research Design
A mixed-methods approach was applied, consisting of qualitative focus group research and quantitative cohort studies using existing data sources from the Netherlands Cancer Registry (NKR), PALGA, and Dutch Hospital Data (DHD). The study focused on patients diagnosed with ovarian, cervical, endometrial, or vulvar cancer between 2015 and 2020, who underwent curative treatment, were alive 3 months post-treatment, and received follow-up care. For the qualitative research, multiple focus groups were organized to gather patient experiences with follow-up care during the COVID-19 pandemic. For the quantitative cohort study, 2 cohorts were defined: a pre-COVID cohort (2017-2019) and a COVID cohort (2020-2022). These cohorts were compared in terms of healthcare utilization, costs, and oncological outcomes.
Results
- Patient Experiences: patients appreciated the flexibility of telephone consultations but emphasized the importance of physical consultations for reassurance. The absence of a fixed point of contact led to feelings of uncertainty.
- Healthcare Utilization: the total number of consultations remained stable, but there was a significant shift from physical to telephone consultations.
- Healthcare Costs: the shift to telephone consultations resulted in a significant reduction in healthcare costs, particularly for ovarian and vulvar cancer.
- Oncological Outcomes: no significant differences were found in two-year recurrence-free survival or overall survival between the pre-COVID and COVID cohorts.
Discussion
Alternative forms of follow-up care, such as telephone consultations, are safe and cost-effective without negatively impacting oncological outcomes. A hybrid care model, combining physical and telephone consultations, is recommended. However, it should be noted that the use of retrospective data may introduce bias. The absence of recurrence data in the NKR was addressed by linking it with PALGA, but this may underestimate recurrence rates. Additionally, the study only examined healthcare utilization within specialized medical care, potentially missing relevant data from primary and paramedical care.
Implications
Implementing hybrid care models can contribute to more sustainable and patient-centered care. Actively involving patients in decisions about the form and frequency of follow-up care is essential.