TY - JOUR
T1 - Patient-led, home-based follow-up for colorectal cancer
T2 - DISTANCE multicentre stepped-wedge cluster randomised trial
AU - van Driel, M. H.Elise
AU - Swartjes, Hidde
AU - Lemmens, Jobbe M.G.
AU - Qaderi, Seyed M.
AU - Teerenstra, Steven
AU - Custers, Jose A.E.
AU - Elferink, Marloes A.G.
AU - van Wely, Bob J.
AU - Bloemen, Johanne G.
AU - van Grevenstein, Wilhelmina M.U.
AU - van Duijvendijk, Peter
AU - Verdaasdonk, Emiel G.G.
AU - de Roos, Marnix A.J.
AU - Coupé, Veerle M.H.
AU - Vink, Geraldine R.
AU - Verhoef, Cornelis
AU - Grünhagen, Dirk J.
AU - de Wilt, Johannes H.W.
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2026/8
Y1 - 2026/8
N2 - Background: Colorectal cancer (CRC) incidence is rising; consequently, 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 was 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 after surgery, were assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (assessed using the European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire (EORTC QLQ-C30); version 3.0), cancer-related worry (assessed using the Cancer Worry Scale (CWS)), and psychological distress (assessed using the Hospital Anxiety and Depression Scale (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 with standard follow-up (rate ratio 0.62 (95% c.i. 0.51 to 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 between the two groups were found with regard to quality of life or psychological well-being. Conclusion: The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.
AB - Background: Colorectal cancer (CRC) incidence is rising; consequently, 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 was 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 after surgery, were assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (assessed using the European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire (EORTC QLQ-C30); version 3.0), cancer-related worry (assessed using the Cancer Worry Scale (CWS)), and psychological distress (assessed using the Hospital Anxiety and Depression Scale (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 with standard follow-up (rate ratio 0.62 (95% c.i. 0.51 to 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 between the two groups were found with regard to quality of life or psychological well-being. Conclusion: The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.
UR - https://www.scopus.com/pages/publications/105046753487
U2 - 10.1093/bjs/znag081
DO - 10.1093/bjs/znag081
M3 - Article
C2 - 42359543
AN - SCOPUS:105046753487
SN - 0007-1323
VL - 113
JO - BJS
JF - BJS
IS - 8
M1 - znag081
ER -