Effectiveness of case management on clinical outcomes in women with cervical cancer: A systematic review with meta-analysis

Abstract

Background

Cervical cancer is the fourth common type of cancer and can be deteriorated by insufficient care management. Case management, a collaborative process utilising available resources to satisfy individual health needs and attain cost-effective outcomes, has been applied in management of cervical cancer.

Aims

To evaluate the effectiveness of case management on clinical outcomes in patients with cervical cancer, compared with non-case management care.

Methods

The following databases were searched: Cochrane Gynaecological Cancer Review Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science. Grey literature searches were performed as well until September 2017. For continuous outcomes, the mean difference or standardised mean difference along with 95% confidence interval were extracted; for dichotomous data, the corresponding odds ratio with 95% CI was calculated. A fixed- or random-effect model is applied for meta-analysis when appropriate. Heterogeneity was assessed by the I² statistics.

Results

Ten studies were included in this review, comprising four randomised controlled trials and six non-randomised studies and involving 5980 participants with low to moderate overall risk of bias. Case management interventions varied in the models and contents. During diagnosis identification phase, the case management groups were improved significantly in adherence to follow-up in six months and over twelve months; in timely diagnosis resolution in two months, twelve months and eighteen months; and in time to initiation of colposcopy follow-up and time to diagnosis resolution. During treatment period, case management was found more effective at the following items: the rate of patients continuing treatment in the same institute; the rate of planned readmission for active treatment in fourteen days; the rate of planned readmission for active treatment in 15-30 days. There were no statistical differences in treatment phase between groups in the rate of prolonged hospitalisation, the rate of nonadherence to treatment, and the rate of unplanned hospital readmission. Several studies concluded that age, insurance status, literacy ability, and severity of screening abnormality may affect follow-up behaviour.

Conclusion

Relatively robust evidence is provided by several high-quality studies that case management improves clinical outcomes in cervical cancer at specified time points. Age, insurance status, literacy ability, and severity of abnormality affect the adherence to follow-up and treatment. Whereas in view of heterogeneity in the components of intervention and outcome measures across the included trials, more rigorously-designed studies are needed in the future to explore further cost-effective protocols of case managements maximising adherence to follow-up and treatment, and relevant barriers should be investigated further as well.