Long-term cancer survivors are more likely to rate their follow-up care as high-quality when one main provider is identified and an oncology specialist is involved, according to results of a population-based cross-sectional study among adult survivors of breast, prostate, colorectal, endometrial, and ovarian cancer. Among 1,490 survivors responding to questionnaires 4 to 14 years after diagnosis, 68.7% reported recent follow-up care, 47.4% from oncology specialists only, and 27.6% shared care from oncology and primary care providers. “Most survivors perceived their recent follow-up care as high quality (excellent or very good, 77.3%),” the researchers reported in the Journal of Oncology Practice.
Role of Primary Care Provider
“Survivors who identified a [primary care provider] as their main follow-up care physician were as likely as those identifying an oncology specialist to rate their care as high quality (odds ratio [OR], 2.56; 95% CI, 0.98 to 6.74); however, survivors who could not identify a main follow-up care provider were less likely to report high-quality care (OR, 0.20; 95% CI, 0.08 to 0.50),” the investigators stated.
“Compared with follow-up care by an oncology specialist only, care by a [primary care provider] only was associated with a lower quality-of-care rating (OR, 0.34; 95% CI, 0.13 to 0.91), but there was no significant difference in quality rating by survivors when care was shared by an oncology specialist and [primary care provider] compared with an oncology specialist only.”
The Follow-Up Care Use Among Survivors (FOCUS) study was sponsored by the National Cancer Institute and sampled patient cases from the Surveillance, Epidemiology, and End Results (SEER) cancer registries in California. The researchers represented the University of Southern California, Los Angeles, and the Cancer Prevention Institute of California, Fremont, as well as other facilities.
Among those completing the questionnaire, 66.5% were ≥ 65 years and 64% had early stage cancer (stages 0–II). Slightly more than half (50.6%) identified themselves as from ethnic minorities. Most (79.9%) survivors reported that they were told they needed cancer-related follow-up care, but only 41.7% reported that a physician had discussed late and long-term effects of treatment and only 19.9% said they had received written treatment summaries.
“Endometrial cancer survivors reported the lowest rates of advice regarding follow-up care and late and long-term effects. Prostate cancer survivors had the highest reports of long-term effects advice and treatment summaries,” the researchers noted.
A majority of survivors (82.9%) reported receiving cancer-related follow-up care and almost 40% had three follow-up care visits in the past 2 years. “Follow-up care was most common among ovarian cancer survivors and least common among endometrial cancer survivors,” the investigators
Reasons cited for follow-up care were similar across cancer sites. The most common reason, reported by 71.1%, was checking for recurrence of primary cancer, followed by being screened for other cancers, cited by 66.1%.
“Only 27.8% reported that screening for late effects was a reason for recent care; however, survivors who reported advice about late effects also rated that care as higher quality. Given the critical importance of late effects among long-term survivors, better survivor and provider education regarding the reasons for and content of survivorship care should be a focus of future research and practice,” the investigators commented.
Impact of IOM Report
“Survivors in this study were diagnosed and treated before the 2006 Institute of Medicine report highlighting the importance of cancer-related follow-up care and implementation of formal survivorship care programs at many cancer centers,” the authors stated. “Thus, the rates in our study are lower than those from a 2006 to 2010 national study reporting that 38% of survivors received treatment summaries, and we expect future cohorts to report higher levels.”
The investigators pointed out that the finding that 75% of survivors continued to receive follow-up care from an oncologist or cancer-related specialist “has implications for health care systems looking to constrain cost and meet a growing demand for oncology services. Shared care models have emerged as a way to meet survivors’ complex care needs.” But including multiple providers, the researchers noted, “suggests challenges for care coordination.” ■
Weaver KE, et al: J Oncol Pract. April 1, 2014 (early release online).