A new study in the Journal of Oncology Practice (JOP) finds that while primary care physicians (PCPs) are often involved in cancer survivorship care, many do not feel adequately prepared for key components of it.
With an estimated 16.9 million cancer survivors currently in the United States, a number projected to increase by 29.1% to 21.7 million by 2029, the need to optimize the care between oncology and primary care is imperative.i
The new study titled, “Practice, Preferences and Practical Tips from Primary Care Physicians to Improve Care of Cancer Survivors,” shares the results of a survey of 117 PCPs in practices affiliated with a large academic medical center to evaluate four key areas:
- Current practices in care of cancer survivors
- Sense of preparedness to deliver such care
- Barriers to care of cancer survivors
- Preferences for shared care and communication between PCPs and oncologists
A majority (82%) of respondents had been practicing for more than 10 years and saw a median of 36 patients per week. Nearly all survey respondents reported that they commonly assume primary responsibility for at least some aspects of survivorship care. Key results of the survey include:
Practice of and Perceived Preparedness for Care of Survivors
- 94% percent reported that they may assume primary responsibility for managing and/or making referrals for psychological consequences of cancer or its therapy.
- However, only 25% reported that they felt very prepared to do so.
- 84% reported regularly assuming primary responsibility for the management of chronic physical complications of cancer therapy.
- Yet, only 10% felt very prepared to do so.
- 65% felt unprepared to screen for late complications.
- 36% felt unprepared to screen for recurrence.
Barriers to Providing Care to Survivors
- 73% were uncertain about delegation of responsibility.
- 72% lacked needed training.
- 56% reported that patient preference to have their oncologist manage cancer-related issues served as a barrier.
- 34% reported feeling that oncologists preferred to manage cancer-related issues.
Attitudes Toward and Experiences with Shared Care and Communication
- 58% believed that PCPs should have primary responsibility for cancer-related follow-up care in the survivorship period.
- 32% believed that oncology should always be responsible for cancer-related care.
- 97% wanted access to a cancer treatment summary, and 78% reported that they generally had such access.
- 98% reported that they wanted a survivorship care plan with explicit follow-up care recommendations, but only 11% reported regularly having such access.
The survey also showed that there is great variation in PCPs’ communication preference. While a majority preferred a summary of the patient’s cancer history and survivorship care needs in the patient’s active problem list within the institution’s EHR, others wanted a distinct survivorship section, or inclusion within the Health Maintenance section, or a one-time note outlining the plan for survivorship care.
Variation was also found for how they communicated with the oncology team. For non-urgent matters, most respondents preferred EHR based communication via a direct message or copied note, while others preferred email. PCPs reported that they were slightly more likely to receive a prompt response to oncology questions when asked over email compared to messages through the EHR. Nearly all respondents reported that they typically want to be notified of important clinical events.
This study delivers an important message to the oncology community—primary care providers are able and willing to take part in the shared care of cancer survivors. Nearly all PCPs in the study (95%) felt that medical oncologists and primary care physicians should share responsibility for survivorship care. However, clear communication and consensus are needed for patient-specific complications, screening needs, and long-term risks of therapy.
ASCO is committed to survivors of cancer, who require long-term surveillance, risk assessment, and prevention services. The Society’s Cancer Survivorship Committee has developed a comprehensive agenda to assist the oncology community in the delivery of quality survivorship care.
ASCO has also created the Survivorship Care Compendium, a repository of tools and resources enables oncology providers to implement or improve survivorship care within their practices. The compendium serves as an accompaniment to the educational opportunities and clinical-guidance ASCO offers on survivorship care.
Earlier this year, ASCO and the American Cancer Society (ACS) released national strategies for meeting the needs of the growing population of cancer survivors in the US while addressing provider shortages and rising costs. These strategies were based on a summit that the two organizations convened in January of 2018 focused on developing and implementing care that addresses these issues by treating patients in personalized follow-up care pathways depending on the type and level of resources needed for their long-term care.
Read the full JOP article.
i. Projections based on data from Figure 1 in Bluethmann SM, Mariotto AB, Rowland, JH. Anticipating the ''Silver Tsunami'': Prevalence Trajectories and Comorbidity Burden among Older Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25:1029-1036.