Cancer Survivors Prefer Follow-up Treatment From Specialists

Roxanne Nelson

September 24, 2012

September 24, 2012 — Even though almost one third of all cancer-related office visits take place in the primary care setting, many patients have concerns about seeing their primary care physician for follow-up cancer care.

In a small study in which in-depth interviews were conducted with cancer survivors, 52% reported feeling that cancer survivors should see an oncology specialist rather than a primary care provider for follow-up cancer care, and 39% reported feeling that there is a role for primary care physicians in such care.

The study was published in the September/October issue of the Annals of Family Medicine.

Lead author Shawna Hudson, PhD, assistant professor of family medicine at the UMDNJ–Robert Wood Johnson Medical School and director of community research at the Cancer Institute of New Jersey in New Brunswick, and colleagues sought to identify the preferences of cancer survivors.

The authors point out that roughly one third of the 36.6 million annual visits for cancer care to physician offices are to primary care providers. With a medical oncologist shortage looming, a multifaceted strategy will be needed to provide follow-up care, they note; it is likely that the primary care setting will become the main medical home for cancer patients who have completed their therapy.

Dr. Hudson and colleagues recruited 42 survivors of early-stage breast or prostate cancer at least 2 years after the completion of active cancer treatment. The survivors were 47 to 80 years of age, 76% were women, 69% were white, 26% were black, 2% were Asian, and 2% were Latino.

The vast majority (90%) reported that they were currently being cared for by a primary care physician. In addition, 76% reported receiving follow-up care in the previous year from some type of cancer specialist (medical oncologist, surgical oncologist, or radiation oncologist), 36% reported receiving follow-up care from a cancer-related specialist (urologist), and/or 19% reported receiving follow-up care from a primary care physician (family physician, general internist, or gynecologist). Several survivors reported receiving care from multiple physicians.

Some Role for Primary Care

More than half of survivors had a strong preference for receiving follow-up care from an oncologic specialist. They cited several disadvantages of follow-up care from a primary care physician: a lack of cancer expertise, limited or no involvement with the original cancer care, and a lack of care continuity.

Survivors who believe there is a role for primary care clinicians in follow-up cancer care suggested that they could perform routine preventive screening, provide supplemental care, and provide follow-up care when "enough time had passed." Of the 21% of survivors who believe there is a point in the future when a primary care physician could function as their main provider, most felt that it would be after 5 years of follow-up or after the completion of any medications.

Others believe that a primary care clinician could take over their care when they are ready to reintegrate into the general population.

Some survivors described "shared care" between the oncologist and primary care physician as "the only context in which a primary care physician should provide follow-up care."

Survivors who believe there is a role for primary care clinicians in this setting were more like to have a college education than those who did not believe there is a role (67% vs 27%; P = .021). However, there were no differences in these 2 group in demographic characteristics, such as age, race, income, the location of treatment, self-reported health, and the number of years since the end of treatment.

"Findings from this study support the need for primary care [physicians] to engage meaningfully in the case management of our growing population of adult cancer survivors," the authors conclude. "This study highlights the need for future research and interventions to address both patient and patient-perceived physician knowledge gaps related to cancer follow-up care."

The study was funded by grants from the National Cancer Institute, the Department of Defense, the Cancer Institute of New Jersey's Survey Research and Qualitative Methods Shared Resource, and Fox Chase's Behavioral Research Core Facility. The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2012;10:418-427. Abstract