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Few oncologists consistently provide survivorship care plans to patients
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Most oncologists and primary care providers fail to consistently discuss and provide survivorship care plans with patients who completed cancer treatment, according to study results.
Researchers conducted a survey to assess the frequency with which oncologists and PCPs provided written survivorship plans to or discussed survivorship care recommendations with patients. The investigators also evaluated the factors associated with clinicians’ completion of those tasks.
The analysis included a nationally representative sample of oncologists (n=1,130) and PCPs (n=1,020).
Most oncologists (64%; 95% CI, 61.3-66.7) indicated they always or almost always talk with cancer survivors about survivorship care recommendations, and about half indicated they always or almost always talk with survivors about which physician would be responsible for follow-up of their cancer care (50%; 95% CI, 46.8-53.2) or other medical issues (42.2%; 95% CI, 38.9-45.6). About one-third of oncologists (31.7%; 95% CI, 28.8-34.6) indicated they always or almost always talked with survivors about all of those issues.
Fewer than one in 10 oncologists (9.6%; 95% CI, 8-11.5) indicated they always or almost always provide written survivorship care plans to patients, and 4.8% (95% CI, 3.6-6.4) reported they always or almost always provide cancer survivors with a written document and talk with them about survivorship recommendations and provider responsibilities.
Oncologists were more likely to provide written survivorship care recommendations (OR=1.73; 95% CI, 1.22-2.44) and to discuss survivorship care planning (OR=2.02; 95% CI, 1.51-2.7) if they reported detailed training about the late and long-term effects of cancer.
Further, PCPs who indicated they always or almost always received treatment summaries and follow-up care plans from oncologists were more than nine times as likely (OR=9.22; 95% CI, 5.74-14.82) to talk with patients about survivorship care than those who did not consistently receive those documents.
“These nationally representative provider-reported data suggest that oncologists rarely reported consistently providing written survivorship care plans to survivors, and that oncologists and PCPs often failed to discuss survivorship care recommendations and delineation of provider responsibility for follow-up care with survivors,” the researchers wrote. “These data provide a useful benchmark to assess implementation of new mandates affecting the care of cancer survivors. The next step is to develop intervention studies to test the hypothesis that improved care coordination and enhanced physician survivorship training will increase the frequency of survivorship care discussions and downstream consequences, such as survivor adherence to care recommendations, quality of life and survival.”
Disclosure:The researchers report no relevant financial disclosures.
Perspective
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Anne Blaes, MD
The study by Blanch-Hartigan and colleagues is the first of its kind to estimate the use and knowledge of survivorship care amongst providers. It suggests that there is an underutilization of survivorship care plans by oncologists. It also suggests that oncologists are much more likely to provide survivorship care documents and to provide education about survivorship issues if they themselves have received more training in the long-term complications and survivorship issues associated with patients. Finally, the study also makes it clear that primary care physicians provide better care when they receive survivorship care plans. Those who received survivorship care plans were nine times more likely to discuss survivorship care and follow-up recommendations with their patients when they have received these documents.I commend the authors for performing this research. It provides a platform for all of us to recognize that we need to do a better job developing and completing survivorship care plans. It also suggests we need to provide more education about long-term complications of cancer therapies and survivorship care to oncologists, primary care physicians and our trainees in these specialties. The initiatives being undertaken by the National Comprehensive Cancer Network and ASCO to help develop better guidelines — some of which were published earlier this spring on fatigue, peripheral neuropathy and depression in Journal of Clinical Oncology — also will be instrumental in providing published documents that can be referred to regarding survivorship care.
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