Improvements Needed in Use of Survivorship Care Plans 


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Laura P. Forsythe, PhD, MPH

Providing [survivorship care plans] to [primary care physicians] may enhance survivorship care coordination, physician-physician communication, and [primary care physicians] confidence.

—Laura P. Forsythe, PhD, MPH, and colleagues

Survivorship care plans, consisting of treatment summaries and follow-up plans, are intended to promote coordination of post-treatment cancer care, but little is known about how survivorship care plans are being used in routine oncology practice. In a study reported in the Journal of the National Cancer Institute, Laura P. Forsythe, PhD, MPH, of the Patient Centered Outcomes Research Institute (PCORI) in Washington, DC, and colleagues examined the frequency with which oncologists provide survivorship care plans or treatment summaries to primary care physicians and characteristics of oncologists/primary care physicians who report frequent provision/receipt.1

They found that a minority of oncologists/primary care physicians report always/almost always providing/receiving survivorship care plans and that oncologists who reported detailed training in late- and long-term effects of cancer and use of electronic medical records were more likely to report providing survivorship care plans. 

Study Details

In the study (Survey of Physician Attitudes Regarding the Care of Cancer Survivors, SPARCCS), a nationally representative sample of medical oncologists (n = 1,130) and primary care physicians (n = 1,020) were surveyed regarding follow-up care for breast and colon cancer survivors. The study evaluated oncologist- and primary care physician–reported provision/receipt of treatment summaries and survivorship care plans (combined treatment summary and follow-up care plan), and characterized oncologists who report consistently providing treatment summaries and survivorship care plans to primary care physicians.

In addition, the investigators examined associations between primary care physician–reported receipt of treatment summaries or survivorship care plans and primary care physician–perceived indicators of care coordination, physician-physician communication, and confidence in knowledge about survivorship care. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and survivorship care plans to primary care physicians (always/almost always vs less frequent).

Oncologists saw an average of 35 breast or colon cancer survivors per week, and primary care physicians saw approximately 38 breast or colon cancer survivors per year.

Survivorship Plan Provision and Receipt

Overall, 49.1% of oncologists reported always/almost always providing treatment summaries, and 20.2% reported always/almost always providing survivorship care plans. In contrast, 34.2% of primary care physicians reported always/almost always receiving treatment summaries (P < .001), and 13.4% reported always/almost always receiving survivorship care plans (P = .001).

Fewer than 5% of oncologists and primary care physicians reported always/almost always providing or receiving care plans without treatment summaries. A greater proportion of oncologists reported providing treatment summaries (76.0%) and survivorship care plans (47.7%) at least “often,” compared with reported receipt by primary care physicians (63.9% and 34.2%). Fewer than 5% of oncologists and primary care physicians reported “never” providing/receiving treatment summaries or survivorship care plans.

Oncologist Characteristics

Among oncologists, detailed training in late and long-term effects (odds ratio [OR] = 1.74), use of partial (OR = 1.64) or full (OR = 2.13) electronic medical records in clinical practice, Asian (OR = 1.68) or “other” (OR = 2.00) race/ethnicity, and older age (OR = 1.03 per year) were significantly positively associated with always/almost always providing treatment summaries to primary care physicians (all P < .05).

Detailed training in late and long-term effects (OR = 2.33), use of partial (OR = 1.63) or full (OR = 2.53) electronic medical records, and Asian race/ethnicity (OR = 1.77) were significantly positively associated with always/almost always providing survivorship care plans (all P < .05), whereas an oncology practice size of 6 to 15 physicians (OR = 0.77) or ≥ 16 physicians (OR = 0.65) was inversely associated with survivorship care plan provision (P = .05 for trend).

Primary Care Physician Characteristics

Compared with primary care physicians reporting receiving neither treatment summaries nor survivorship care plans, primary care physicians who reported always/almost always receiving survivorship care plans were more likely to report never having uncertainty or difficulties related to care coordination, always communicating with other physicians about cancer care and care for other medical issues, and being very confident in knowledge about surveillance, late and long-term effects, and psychosocial needs (all P < .05).

Primary care physicians who reported always/almost always receiving survivorship care plans were more likely than primary care physicians who received treatment summaries alone to report always communicating with other physicians about cancer care and other medical issues and being very confident in knowledge about late and long-term effects (both P < .05). Primary care physicians who reported receiving treatment summaries alone were more likely to report never having difficulties transferring patient care responsibilities (P < .05) compared with primary care physicians who reported receiving neither treatment summaries nor survivorship care plans.

The investigators concluded, “Providing [survivorship care plans] to [primary care physicians] may enhance survivorship care coordination, physician-physician communication, and [primary care physicians] confidence. However, considerable progress will be necessary to achieve implementation of sharing [survivorship care plans] among oncologists and [primary care physicians].” ■

Disclosure: The study was supported by the National Cancer Institute and American Cancer Society Behavioral Research Center Intramural Research funds. For full disclosures of the study authors, visit jnci.oxfordjournals.org.

Reference

1. Forsythe LP, Parry C, Alfano CM, et al: Use of survivorship care plans in the United States: Associations with survivorship care. J Natl Cancer Inst 105:1579-1587, 2013.


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