Short summary

This study is a prospective longitudinal mixed-methods study. In the initial qualitative study, we will develop, feasibility test, adjust, and implement a virtual cross-sectoral team conference between the municipal healthcare center, the general practitioner, and the late effect clinic, resulting in a collaborative treatment plan. In the quantitative study we will evaluate whether the collaborative treatment plan reduces symptom burden and increases patients' quality of life.

Rationale

The negative impact of late effects on cancer survivors' quality of life is well-documented. However, Denmark has no overall strategy for management of late effects after cancer. The role and responsibilities of late effec clinics, municipalities, and general practitioners are unclear. Cancer Plan V emphasizes that most treatments for late effects should be managed in general practice and municipalities, yet, optimal implementation remains unclear. We aim to develop and test a clinical cross-sectoral workflow, with collaborative treatment plans to improve quality of life for patients with complex late effects. Furthermore, to systematize knowledge-sharing between the regional late effect clinics, municipal healthcare professionals and general practitioners benefitting all cancer survivors.

Description of the cohort

Patients referred to one of the five regional late effect clinics are eligible, if they are ≥18 years old, treated for cancer with curative intent, suffering from complex late effects, and able to read and understand the written informed consent. In the qualitative study, we will include 60 patients (four cycles of 15 patients), and in the quantitative study, we will include 280 patients.

Data and biological material

We will collect demographic data (age, sex, cohabitation, education, employment) and health data from medical records (cancer diagnosis, cancer treatments, comorbidities, late effects, treatments for late effects) on all participans. Furthermore, we will collect questionnaire data on all participants (EORTC QLQ-SURV100).

Collaborating researchers and departments

Department of Oncology, Zealand University Hospital

• Lena Saltbæk

Department of Oncology, Sønderborg Hospital, Sygehus Sønderjylland

• Carina Ørts Christensen

Department of Oncology, University Hospital of Southern Denmark, Vejle

• Lise Ventzel

Department of Oncology, University Hospital of Southern Denmark, Esbjerg

• Cathrine Lundgaard Riis

Department of Oncology, Odense University Hospital

• Lærke Tolstrup
• Karin Dieperink
• Lisbeth Birkelund