The first national survey of barriers perceived by primary care physicians (PCPs) and medical oncologists (MOs) in the care of breast and colon cancer survivors showed that primary care doctors were significantly more likely than oncologists to report frequently ordering tests or treatments as malpractice protection. They also more often reported being concerned about a lack of adequate training to manage breast and colorectal cancer survivors‟ health needs.

There are nearly 12 million cancer survivors in the U.S. today, up from 3 million in the 1970s. Once active cancer treatment ends, most survivors eventually transition to primary care physicians for ongoing follow-up care. The authors suggest that the study findings show the need for improved physician education and training in survivorship care planning for an ever-growing population of long-term cancer survivors.

"Cancer survivorship care is becoming particularly important today, as more and more patients are living longer and experiencing late effects, both physical and psychosocial," said lead author Katherine Virgo, PhD, MBA, managing director of health services research at the American Cancer Society in Atlanta. "The results highlight the need for increased coordination among clinicians in cancer survivorship care. Cancer survivorship can be difficult to navigate, and a team effort is needed to help individuals successfully make the transition from patient to survivor. Many physicians are asking what additional training they need to be able to deal with these issues."

According to Dr. Virgo, a variety of barriers – medical, financial and geographic – pose challenges to coordination among clinicians who provide survivorship care. Patients may receive care from several different physicians, sometimes in far-reaching locations over long periods of time throughout their disease and their lives. The Survey of Physician Attitudes Regarding the Care of Cancer Survivors, jointly developed and funded by the National Cancer Institute and the American Cancer Society – was aimed at comparing views of primary care doctors and oncologists on follow-up testing, roles, knowledge, self-confidence and perceived barriers to survivorship care.

More than 2,000 PCPs (1072) and MOs (1130) providing care to breast and colon cancer survivors completed the survey. In their focus on the follow-up care of patients completing treatment five or more years ago, the investigators found that MOs perceived different physician-based barriers as problematic compared to PCPs. MOs were more likely to report concerns about duplicated care, and about which physician should provide general preventive care. They were less likely to report inadequate training and less likely to often/always order extra tests due to malpractice concerns.
Primary care doctors more frequently expressed concern about missed care than did oncologists. Such care might include follow-up to detect and treat recurrences, new primary tumors, and late or long-term effects of cancer and cancer treatment. Guidelines regarding the follow-up care of cancer survivors tend to be more explicit for the initial five years after treatment, but less so beyond five years. PCPs seem aware that there is something else they should be doing for their patients, but are unclear as to what that "something else" is, Dr. Virgo said.

Dr. Virgo stressed the need for better planning, despite a lack of survivorship care standards for many cancers. "For patients transitioning back to the primary care physician for their care, it‟s essential to have a treatment summary and survivorship care plan to ensure continuity and coordination of care."



Source: ASCO

Reference: Abstract: CRA9006 Barriers in providing breast and colorectal cancer survivorship care: perceptions of US primary care physicians (PCPs) and medical oncologists (MOs). K. S. Virgo, C. C. Lerro, C. N. Klabunde, C. Earle, P. A. Ganz