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Oncologists are patients' preferred providers of follow-up care
Mayer EL. J Clin Oncol. 2011;doi:10.1200/JCO.2011.36.9264.
A study of breast cancer survivors indicated that oncologists were still the most preferred providers of follow-up care and lead to the greatest patient-perceived effect on survival, worrying and stress related to cancer.
For the study, researchers queried 218 breast cancer survivors about their preference for follow-up care from an oncologist, primary care physician (PCP) or nurse practitioner, or a virtual visit.
Results indicated that almost 90% of patients still viewed their oncologist as the preferred provider of follow-up care for their cancer; however, 70.2% said that PCPs had either some or all responsibility for screening for cancer recurrence.
Instead, patients identified PCPs as being responsible for general health and treatment of other medical problems. In addition, 72% of patients said that PCPs were responsible for screening for new cancers, as well.
Overall, oncologists were still favored over PCPs or nurse practitioners for reducing worrying related to cancer (OR=2.21; P<.001), reducing stress (OR=1.4;P=.002) and improving cancer survival (OR=2.38; P<.001).
Despite this, patients expressed a high level of comfort with having PCPs or nurse practitioners (NPs) conducting survivorship care, but they were not comfortable with virtual visits.
"Despite a trend toward greater oncologist contribution to survivorship care, it is unclear that such a trajectory is beneficial," researchers wrote. "Specialists' offices are often overcrowded and farther from patients' homes, with longer wait times, shorter appointments, and a higher mean cost per visit compared with a primary care clinic."
As the number of cancer survivors increase, the ability to find new models of survival care will become more important, they added.
"Oncology-focused follow-up care at NP-led survivorship clinics, hybridized with greater implementation of survivorship care plans for PCP guidance, may enhance survivor care," the researchers wrote. "Increased familiarity with the virtual visit will be necessary before any introduction of this visit type into the survivor patient population. Ultimately, improved paradigms to coordinate care among all providers will result in optimal follow-up care for the growing population of cancer survivors."
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.
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A quarter of the entire cancer survivor population in the United States consists of breast cancer survivors. It is imperative that these survivors maintain long-term contact with the health care system in order to address issues related to screening, early detection and management of disease recurrence, treatment-related morbidities and other comorbidities. This study is one of the first to evaluate models of long-term care from the survivors' perspective. The findings indicate that patients are most comfortable with the medical oncologists with respect to their breast cancer care (ie, recurrence/survival) but are more comfortable with primary care physicians (PCPs) with respect to management of comorbidities and treatment-related toxicities.
The study demonstrates quite nicely that a hybrid approach, with more intense follow-up by the oncologist for recurrence-related care combined with PCP-driven health care promotion, may provide the optimal care for the survivors. This requires clear communication between the medical oncologist and the PCP. A model that has been discussed by the authors, and that is currently being practiced in certain survivorship clinics, is a nurse practitioner-led model in which clear risk-based recommendations for disease surveillance, as well as screening for treatment-related toxicities and health promotion, are provided by the NP, combined with health education. However, the findings of this study need to be considered in the context of certain limitations. First, the study represents perceptions of a patient population to hypothetical clinical situations. Second, the study does not take into account the extent of primary disease, and hence the risk of disease recurrence among the study participants. These limitations notwithstanding, this study is the first to include the survivors' perspective into the equation when planning their long-term care, and it lays the groundwork for future studies that take the limitations into consideration.
Smita Bhatia, MD
Chair and professor of
population sciences
City of Hope Cancer Center, Duarte, Calif.
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