Impact of an Integrated Hospital-community-patient Chronic Disease Management Pathway on Postoperative Colorectal Cancer Patients

Abstract

Background Surgery is one of the main means of treating colorectal cancer. However, patients with colorectal cancer need to face many physical and psychological problems after surgery, which seriously affects patients' treatment outcomes and quality of life, so how to carry out effective postoperative management is extremely important. Objective To investigate the effectiveness of an integrated hospital-community-patient chronic disease management pathway intervention for postoperative colorectal cancer patients. Methods Based on different postoperative interventions, colorectal cancer patients were divided into a control group (n=40) and a co-management group (n=36) , with the control group implementing conventional postoperative interventions and the co-management group following a constructed integrated chronic disease pathway for co-management. Changes in laboratory indices, recurrent metastasis, death, postoperative complications, quality of life, and anxiety were compared between the two groups before and after surgery. Results Retrospectively selected 80 patients with colorectal cancer who were discharged from the Department of General Surgery at Yangpu Hospital, affiliated with Tongji University, between January 2021 and April 2022, as study subjects. At 3 and 6 months postoperatively, patients in the co-management group had lower carcinoembryonic antigen levels than patients in the control group (P<0.001) . The incidence of recurrent metastases was not significantly different from that of the control group at 3 months postoperatively (P>0.05) , while at 6 months postoperatively, the incidence of recurrent metastases was lower in the co-management group than in the control group (5.6% vs. 22.5%, χ2=4.395, P=0.036) ; in addition, the incidence of complications was lower in the co-management group than in the control group at both 3 and 6 months postoperatively (0 vs. 16.2%, χ2=3.981, P=0.046; 5.6% vs. 25.0%, χ2=5.388, P=0.020) . However, the difference in mortality at 6 months postoperatively between the two groups was not significant (2.8% vs. 7.5%, χ2=0.165, P=0.685) . In quality of life scores at 6 months and 1 year postoperatively, the co-management group was higher than control patients (P<0.05) , and the anxiety scores were lower in the co-management group than in the control patients (P<0.05) . Conclusion The integrated hospital-community-patient chronic disease management pathway can reduce postoperative complications, decrease recurrence and metastasis of colorectal cancer, improve quality of life, and improve anxiety symptoms, and is of great value to the prognosis of postoperative colorectal cancer patients.

Keywords

• colorectal cancer|postoperative management|chronic disease management|integrated pathway|retrospective cohort study