Ietje Perfors

136 Chapter 6 Background As cancer incidence is increasing 1 and prognosis is improving 2 more patients live longer with cancer and experience more late effects of treatment, 3 in the presence of co-existing chronic conditions. 4 Consequently, the nature of cancer treatment is shifting towards chronic disease management. This change requires more personalised and integrated care, based on individual preferences and medical profile. 5,6 In primary care based healthcare systems, general practitioners (GPs) may be best positioned to provide continuous, personalised and integrated care during the cancer care continuum. 4,5,7 GPs typically have a longstanding and personal relationship with their patients and are up to datewith their patients’ comorbidities. Additionally, they arewell equipped to provide personalised disease management within the context of the patients’ medical history and personal preferences. 7,8 Traditionally, management of cancer is delivered by in-hospital specialists. Attempts to structurally involve primary care during cancer treatment have hardly been successful. 9 Even though patients increasingly want their GP to be involved in their cancer care, 10 the effects of more primary care involvement are unknown. Aiming to involve primary care in cancer care on a more structural basis, we designed an intervention called ‘GRIP’, in close cooperation with medical professionals and patient organisations. The GRIP intervention consists of two steps: (1) a “Time Out consultation” (TOC) with the GP aimed to initiate primary care involvement during cancer treatment, and (2) structured follow- up during and after cancer treatment by a home care oncology nurse (HON) in cooperation with the GP. Earlier we reported the effect of the TOC on perceived shared decisionmaking (SDM) in cancer treatment. 11 We concluded that timely implementation of a TOC in the current cancer care pathway (i.e., between diagnosis and therapy choice) is challenging, mainly because of the tight time schedule between diagnosis and therapy decision. Here we report the effects of the full GRIP intervention in the year after cancer diagnosis on patient satisfaction, healthcare utilisation and patient related outcomes, for patients treated with curative intent.