Oncologists, PCPs Need to Improve Care of Cancer Survivors

Roxanne Nelson

June 06, 2011

June 6, 2011 (Chicago, Illinois) —There are nearly 12 million cancer survivors in the United States today, but coordination of their care remains problematic because of the fragmented healthcare system. Data from the first nationwide study of barriers between primary care practitioners (PCPs) and medical oncologists suggest a need for increased coordination between clinicians, along with a need for improved physician education and training in survivorship-care planning.

"Medical oncologists perceive different physician-based barriers as problematic in follow-up care, compared with PCPs," said lead author Katherine Virgo, PhD, MBA, managing director of health services research at the American Cancer Society in Atlanta, Georgia. "Education and cancer survivorship-care planning may be required to alleviate barriers."

According to study results presented here at the American Society of Clinical Oncology 2011 Annual Meeting, PCPs were significantly more likely to report that they "often/always" order tests or treatments as malpractice protection, because of concern about missed care, and because they lack adequate training to manage patient problems. Alternatively, medical oncologists were more likely to report (often/always or sometimes) being concerned about duplication of care and about which physician should be providing general preventive healthcare.

Dr. Mark Kris

"One thing that we want to do is to return our patients to a normal life," said Mark G. Kris, MD, chief of the thoracic oncology service at the Memorial Sloan-Kettering Cancer Center in New York City, but he emphasized that cancer survivors do have a number of special issues that need to be addressed.

Survivors are at risk for other cancers; they might also have a higher propensity for other health-related issues, and thus need careful management, noted Dr. Kris, who moderated the press briefing at which the study results were highlighted. Many cancer treatments necessitate the need for close follow-up. "We all need optimal training — medical oncologists and others who care for these patients," said Dr. Kris.

View Different Barriers

The study, which was cosponsored by the National Cancer Institute and the American Cancer Society, focused on physician beliefs, knowledge, attitudes, and practices regarding breast and colorectal cancer survivorship care, explained Dr. Virgo.

The initial sample comprised 5275 physicians, including medical oncologists (oncology and/or hematology) and PCPs (family practice, internal medicine, obstetrics/gynecology). Of this group, 1072 PCPs and 1130 medical oncologists providing care to breast and colon cancer survivors completed the survey.

Participating physicians were asked how often they encountered the following problems when caring for breast or colon cancer survivors who completed active treatment 5 or more years ago: ordering tests or treatments as malpractice protection, uncertainty about preventive healthcare responsibility, concern about possible duplicated care, concern about missed care, and lack of adequate knowledge/training.

"Physician specialty was significantly associated with all 5 of the barriers," said Dr. Virgo. "We reexamined these relationships after adjusting for physician demographics, university training, and practice characteristics. After adjustment, 3 of the 5 barriers remained significant."

"Medical oncologists were less likely to report inadequate training and less likely to often/always order extra tests because of malpractice concerns," she said.

The authors found that in multivariate regression models, physician specialty remained significant for 3 of the 5 physician-based barriers. For example, medical oncologists were less likely than PCPs to report inadequate training (odds ratio [OR], 0.33), and less likely to often/always order extra tests because of concerns about malpractice (OR, 0.53). They were also more likely to report being often/always (OR, 1.97) and sometimes (OR, 2.16) uncertain about who is providing patients with general preventive care.

Resolve Fragmentation

"Currently, we have fragmentation, and part of that may be the perceptions of pressures of practicing medicine in 2 very different spheres," said Wendy Demark-Wahnefried PhD, RD, professor in the Department of Nutrition Sciences and associate director for cancer prevention and control at the University of Alabama Comprehensive Cancer Center in Birmingham.

It is important to look at how medical oncologists and PCPs can overcome these different concerns, resolve this fragmentation and improve the care of cancer survivors, added Dr. Demark-Wahnefried, who acted as discussant for the study.

The study was funded by the National Cancer Institute and the American Cancer Society. The authors have disclosed no relevant financial relationships.

American Society of Clinical Oncology (ASCO®) 2011 Annual Meeting. Abstract CRA9006. Presented June 4, 2011.

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