Integrating Primary Care into Cancer Aftercare for Older Patients: A hybrid evaluation of A Pragmatic Non-Randomized Controlled Trial
1
Institute of Global Health, University College London, London, United Kingdom
2
Department of Primary Care and Population Health, University College London, London, United Kingdom
3
Centre of Global Health, Zhejiang University, Hangzhou, China
4
SUSTech-King's Medical School, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A1832
ABSTRACT
INTRODUCTION:
Cancer patients are managed almost exclusively within tertiary care with resulting overburdened healthcare services in China. Although recent policies recommend that primary healthcare centres (PHCs) adopt an expanded role in long-term cancer aftercare, coordination between tertiary hospitals and PHCs remain limited. We conducted a mixed-methods effectiveness-implementation hybrid evaluation of a pragmatic trial integrating PHCs into aftercare of older cancer patients in China.
METHODS:
This trial was conducted at a tertiary oncology hospital in Nantong, Jiangsu, China, with six PHCs as step-down facilities. Patients aged 60 years and older with lung, breast, colorectal, or prostate cancer were approached by tertiary oncologists and allocated to usual care (tertiary aftercare) or the intervention (aftercare plans developed and monitored by tertiary oncologists, delivered by PHC doctors). Effectiveness outcomes were hospital admissions and health related quality of life (HRQoL) at one and three months. A within-trial cost-effectiveness analysis used a modified societal perspective. Process outcomes combined quantitative feasibility indicators with qualitative evidence of patient experience and healthcare providers’ attitudes and behaviour.
RESULTS:
Between May 2023 and April 2024, 755 patients were enrolled; 90 received the intervention and 665 received usual care. Compared with usual care, intervention patients had 43% fewer admissions to tertiary hospital at one month (p=0.002) with no significant difference at three months (p=0.053). The intervention was cost-effective, saving around US$ 407.82 without a loss in HRQoL for patients in the intervention group (mean different = 0.002, 95%CI: -0.004 to 0.008). Process evaluation findings suggested that feasibility and effectiveness were shaped by oncologist clinical workload, willingness to collaborate with PHCs, and ability to identify patients most likely to benefit.
CONCLUSIONS:
Integrating PHCs into cancer aftercare can save costs and reduce resource use without compromising health outcomes. Longer-term studies are needed to inform how PHCs can adapt services to address unmet patient needs.
Cancer patients are managed almost exclusively within tertiary care with resulting overburdened healthcare services in China. Although recent policies recommend that primary healthcare centres (PHCs) adopt an expanded role in long-term cancer aftercare, coordination between tertiary hospitals and PHCs remain limited. We conducted a mixed-methods effectiveness-implementation hybrid evaluation of a pragmatic trial integrating PHCs into aftercare of older cancer patients in China.
METHODS:
This trial was conducted at a tertiary oncology hospital in Nantong, Jiangsu, China, with six PHCs as step-down facilities. Patients aged 60 years and older with lung, breast, colorectal, or prostate cancer were approached by tertiary oncologists and allocated to usual care (tertiary aftercare) or the intervention (aftercare plans developed and monitored by tertiary oncologists, delivered by PHC doctors). Effectiveness outcomes were hospital admissions and health related quality of life (HRQoL) at one and three months. A within-trial cost-effectiveness analysis used a modified societal perspective. Process outcomes combined quantitative feasibility indicators with qualitative evidence of patient experience and healthcare providers’ attitudes and behaviour.
RESULTS:
Between May 2023 and April 2024, 755 patients were enrolled; 90 received the intervention and 665 received usual care. Compared with usual care, intervention patients had 43% fewer admissions to tertiary hospital at one month (p=0.002) with no significant difference at three months (p=0.053). The intervention was cost-effective, saving around US$ 407.82 without a loss in HRQoL for patients in the intervention group (mean different = 0.002, 95%CI: -0.004 to 0.008). Process evaluation findings suggested that feasibility and effectiveness were shaped by oncologist clinical workload, willingness to collaborate with PHCs, and ability to identify patients most likely to benefit.
CONCLUSIONS:
Integrating PHCs into cancer aftercare can save costs and reduce resource use without compromising health outcomes. Longer-term studies are needed to inform how PHCs can adapt services to address unmet patient needs.
| eISSN: | 2654-1459 |
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