Study Finds Primary Care Providers Are Engaged in Cancer Survivorship Care but Report Barriers to Optimal Care Delivery
A new study published by McDonough et al in the Journal of Oncology Practice found that while primary care physicians are often involved in cancer survivorship care, many do not feel adequately prepared for key components of it.
The study shared the results of a survey of 117 primary care physicians in practices affiliated with a large academic medical center to evaluate four key areas: (1) current practices in care of cancer survivors, (2) sense of preparedness to deliver such care, (3) barriers to care of cancer survivors, and (4) preferences for shared care and communication between primary care physicians 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.
Care of Survivors
Among all respondents, 84% reported regularly assuming primary responsibility for the management of chronic physical complications of cancer therapy. However, only 10% felt very prepared to do so. About 65% felt unprepared to screen for late complications, and 36% felt unprepared to screen for recurrence.
In addition, 94% of primary care physicians surveyed 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.
Overall, 73% of those surveyed were uncertain about delegation of responsibility, and 72% lacked needed training. Fifty-six percent reported that patient preference to have their oncologist manage cancer-related issues served as a barrier, and 34% reported feeling that oncologists preferred to manage cancer-related issues.
Shared Care and Communication
Approximately 58% believed that primary care physicians should have the primary responsibility for cancer-related follow-up care in the survivorship period. On the other hand, 32% believed that oncologists should always be responsible for cancer-related care.
Ninety-seven percent wanted access to a cancer treatment summary, and 78% reported that they generally had such access. That said, 98% reported that they wanted a survivorship care plan with explicit follow-up care recommendations, and only 11% reported regularly having such access.
The survey also showed that there is great variation in primary care physicians’ 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 electronic health record (EHR), others wanted a distinct survivorship section, inclusion within the health maintenance section, or a one-time note outlining the plan for survivorship care.
Variation was also found for how primary care physicians communicated with the oncology team. For nonurgent matters, most respondents preferred EHR-based communication via a direct message or copied note, whereas others preferred e-mail. Primary care physicians reported that they were slightly more likely to receive a prompt response to oncology questions when asked over e-mail 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 primary care physicians 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.
Disclosure: For full disclosures of the study authors, visit jop.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
