C3 Feasibility Study: Improving management of comorbidity in patients with colorectal cancer

About the project

Colorectal Cancer (CRC) is New Zealand's second most common cancer, affecting predominantly older adults. Seven out of ten patients diagnosed with CRC have at least one other co-existing condition (comorbidity). Evidence suggests patients with comorbidity may have potentially curative treatment unnecessarily modified, with a detrimental impact on their survival. Furthermore their complex health needs often leads to fragmented care. Some small international studies have shown that older patients who undergo Comprehensive Geriatric Assessment (which includes proactive management of comorbidity, evaluation of mental health and functional status) are more likely to complete treatment and have fewer side-effects from chemotherapy. This study is trialling an intervention aimed at coordinating care and managing comorbidity in patients newly diagnosed with CRC.

This feasibility study is piloting the utility of the proposed screening tool combined with broad comprehensive medical assessment (CMA) in three centres (Palmerston North, Invercargill and Dunedin) with the aim of improving care coordination, treatment uptake and reducing cancer treatment toxicity.

Project aims

The overriding study questions for this study are:

• Does active management of comorbid conditions at the time of colorectal cancer diagnosis a) reduce unplanned hospitalisations and/or b) improve quality of life and/or c) improve uptake and tolerability of treatment?
• Does active management of comorbid conditions at the time of colorectal cancer diagnosis increase all-cause and cancer-specific survival?

The outcomes from this initial feasibility project will be to:

1. Identify the extent of co-existing comorbidity,
2. estimate the costs and benefits associated with improving comorbidity management,
3. identify the feasibility of a multi-morbidity intervention across inpatient and outpatient setting,
4. assess the impact of case management on times to treatment, particularly where multi-morbidity may require further medical assessments,
5. improve the pathway management for patients with complex health needs.

Funders

University of Otago through an Otago Medical School Collaborative Grant
Southern District Health Board through Health Service Delivery Grant

Our People

University of Otago

• Diana Sarfati; University of Otago, Wellington
• Christopher Jackson; Professor in Medicine, University of Otago and Medical Oncologist, Southern DHB
• Dr Stephen Chalcroft, Older Persons' Health, Clinical Senior Lecturer, Department of Medicine, Dunedin School of Medicine
• Virginia Signal; PhD student and research nurse, Department of Public Health, University of Otago Wellington
• James Stanley; Biostatistician, Dean's Department, University of Otago, Wellington
• Dr Marie McLaughlin, Older Persons' Health, Clinical Senior Lecturer, Department of Medicine, Dunedin School of Medicine
• Dr Stephanie Farrand, Older Persons' Health, Clinical Senior Lecturer, Department of Medicine, Dunedin School of Medicine
• Professor John McCall, Department of Surgical Sciences, Dunedin School of Medicine

External to University of Otago

• Dr Kirsten Holst, Geriatric Medicine (Midcentral Health)
• Dr Claire Hardie, Associate Dean Undergraduate Studies and Radiation Oncologist (Midcentral Health)
• Tracey Steiner, research nurse, Oncology Research Unit, Southern Blood and Cancer, Southern District Health Board