Oncologists, PCPs disagree on who should provide cancer survivorship care

Issue: February 25, 2016

Oncologists and primary care physicians within the same integrated health system disagreed on who should ultimately manage care for survivors of cancer, according to findings presented at the Cancer Survivorship Symposium.

This could eventually lead to cancer survivors not receiving appropriate or timely follow-up care within an integrated health system.

“In a large public health system, we found significant uncertainty as to who is responsible for care of cancer survivors,” Bijal A. Balasubramanian, MBBS, PhD, assistant professor in the department of epidemiology, human genetics and environmental sciences at The University of Texas School of Public Health – Dallas Regional Campus and member of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, told HemOnc Today. “Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized.”

National data indicate significant differences between PCPs and oncologists regarding their knowledge, attitudes and practices of the care of cancer survivors. However, there have been no available data to determine whether these attitudes and practices differ between PCPs and oncologists within the same health system, even though they have access to the same health records and infrastructure.

Balasubramanian and colleagues conducted this study to compare attitudes and practices of PCPs and oncologists for follow-up care of cancer survivors.

The investigators issued a survey to 41 PCPs and 24 oncologists within the same safety-net health system in Dallas. The survey assessed the preferred models of care delivery for all clinicians, attitudes toward follow-up care and cancer surveillance practices.

Based on a 52% response rate, the researchers found that 35% of the PCPs preferred that an oncologist lead the care delivery, whereas 30% of oncologists preferred a shared-delivery approach. Twenty-two percent of oncologists preferred an oncologist-led approach.

No PCPs indicated that they preferred a PCP–led model, whereas 17% of oncologists preferred that method.

PCPs and oncologists agreed that PCPs have the skillset to initiate cancer surveillance; however, more PCPs felt that way than oncologists (73% vs. 59%).

Further, 56% of PCPs and 42% of oncologists indicated that PCPs should not have the primary responsibility for follow-up cancer care.

The greatest difference in attitudes occurred regarding cancer surveillance practices, including who ordered tests for cancer surveillance, and evaluated patients for disease recurrence and adverse treatment- or disease-related effects, and managed adverse outcomes from treatment.

A high proportion of PCPs (approximately 40%) reported that oncologists primarily performed these surveillance services, whereas a majority of oncologists (approximately 75% to 80%) reported that PCPs performed these duties.

Further, approximately 50% of oncologists said PCPs screened survivors for long-term psychological effects, whereas 20% of PCPs said oncologists did so.

This imbalance suggests cancer survivors may not receive recommended care and that guidelines are needed to determine the shared responsibilities for these survivors.

“Our study highlights a critical problem in planning care for cancer survivors,” Balasubramanian said. “Should oncologists or PCPs be responsible for follow-up of cancer survivors, or should the responsibility be shared?

“It is imperative that these issues are addressed in developing effective models of care delivery to care for the significant number of people living with cancer,” she said. – by Anthony SanFilippo

Reference:

Balasubramanian BA, et al. Abstract 105. Presented at: Cancer Survivorship Symposium; Jan. 15-16, 2016; San Francisco.

For more information:

Bijal A. Balasubramanian, MBBS, PhD, can be reached at bijal.balasubramanian@utsouthwestern.edu.

Disclosure: HemOnc Today was unable to obtain a list of relevant financial disclosures at the time of reporting.