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405 Self-management and adherence to recommended follow-up after gynaecological cancer: results from the international InCHARGE study
  1. M Skorstad1,
  2. B De Rooij2,3,
  3. MM Jeppesen4,5,
  4. SH Bergholdt6,
  5. PT Jensen7,
  6. N Ezendam2,3,
  7. K Lindemann8,9,
  8. T Bohlin10,
  9. L Van de Poll-Franse2,3,11 and
  10. I Vistad1,12
  1. 1Sorlandet Hospital HF Kristiansand, Dept. of Gynaecology and Obstetrics, Norway
  2. 2Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
  3. 3CoRPS – Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical psychology, Tilburg University, Tilburg, Netherlands
  4. 4Lillebaelt Hospital, Dept. of Gynaecology and Obstetrics, Kolding, Denmark
  5. 5Odense University Hospital, OPEN, Odense Patient data Explorative Network, Odense, Denmark
  6. 6Odense University Hospital, Dept. of Gynaecology and Obstetrics, Odense, Denmark
  7. 7Aarhus University Hospital and Aarhus University, Dept. of Gynaecology and Obstetrics, Aarhus, Denmark
  8. 8Oslo University Hospital, Dept. of Gynaecologic oncology, Division of Cancer Medicine, Oslo, Norway
  9. 9University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
  10. 10Vestfold Hospital Trust, Dept. of Gynaecology and Obstetrics, Tonsberg, Norway
  11. 11The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
  12. 12University of Bergen, Clinical Institute II, Medical department, Bergen, Norway


Introduction/Background*The growing number of cancer survivors has led to increased focus on follow-up care. Resent follow-up strategies tend to shift towards personalised care with focus on patient education and self-management. There are limited data on gynaecological cancer survivors’ self-management abilities. This study aimed to assess the relationship between self-management skills and adherence to current follow-up guidelines among gynaecological cancer survivors in the Netherlands, Norway, and Denmark. We also assessed the relationship between adherence to follow-up and use of additional healthcare services.

Methodology We conducted an international, multi-centre, cross-sectional study. Gynaecological cancer survivors were recruited 1–5 years after completion of treatment. We obtained information on clinical characteristics, demographics, self-management (Health Education Impact Questionnaire), follow-up visits, and use of healthcare services by validated questionnaires. Based on national guidelines, we categorised participants as adherent if they attended the recommended number of follow-up visits, non-adherent if they had fewer visits than recommended, or over-users if they had more visits than recommended.

Result(s)*Of 4455 invited survivors, 2428(55%) returned the questionnaires. After excluding 992 randomly selected Danish survivors to even the distribution between countries and survivors with more than 5 years follow-up, 911 survivors were included in the study. Survivors with high self-management skills (e.g. ability to manage medical and psychosocial aspects of one’s illness) most frequently attended the recommended number of follow-up visits. There were lower self-management skills in the health-directed activity domain, indicating less health-promoting physical activity (OR 1.54, 95% CI 1.03-2.32) among non-adherent survivors compared to adherent survivors. No other associations between self-management and follow-up adherence were revealed. Non-adherent survivors were likely to be older, treated by surgery only, Danish residents and have endometrial cancer. Over-users not only reported more follow-up visits but also used additional healthcare services, such as oncologic rehabilitation and/or oncological nurses, more frequently than adherent survivors.

Conclusion*Possession of low self-management skills appears to reduce the likelihood of adhering to national guidelines for gynaecological cancer follow-up. As personalisation of care is gradually implemented, a special attention on patient education for survivors at risk of low self-management may help to ensure their adherence to recommended follow-up.

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