Primary care-led survivorship clinics require risk stratification, ‘therapeutic alliance’
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Primary care providers play a key role in cancer survivorship, according to a presenter at the Cancer Center Survivorship Research Forum.
Erin E. Hahn, PhD, MPH, health services researcher and implementation scientist at Kaiser Permanente Southern California, presented preliminary findings and highlighted the progress of an ongoing clinical trial she is leading to assess the development and implementation of a primary care-led survivorship clinic for survivors of early-stage breast or colorectal cancers.
“I always call it a ‘good problem’ — we’ve had such success with our diagnostics, our screening programs and our treatments, and progress has really accelerated,” Hahn told Healio. “So, we have this growing population of patients who do very well on their treatment. They’ll live for many, many years after their treatment ends. So, how do we take care of them?”
Importance of risk stratification
During her presentation, Hahn outlined some of the main goals of the primary care-led survivorship clinic her team at Kaiser Permanente has developed and implemented.
Risk stratification is a key component.
“We’re really trying to set the stage to start transitioning patients earlier in their treatment course,” Hahn said. “That means we need to be able to identify patients who have done well on their treatment and are considered low risk — patients who oncologists would feel comfortable referring to a primary care-led clinic.”
Hahn and colleagues used the Epic electronic medical record system to develop a screening algorithm to identify low-risk survivors of breast cancer or colorectal cancer. They relied on data from pathology, treatment and utilization to identify eligible patients.
“This idea of risk stratification has been very important in trying to figure out new models of care,” Hahn told Healio. “These access issues in oncology just keep coming.”
Researchers have been monitoring the effectiveness of the algorithm, which identifies low-risk patients based on the characteristics of their cancer and the timeframe of their treatment completion.
“Leaving everything on the shoulders of our physicians to find a patient who is a good candidate for this is not a good model,” Hahn said. “We have this very nice, streamlined way to find the patients and to engage the oncologist in the discussion.”
Communication and education
Hahn and colleagues also spent considerable time training primary care providers in survivorship care for the low-risk patients they identified.
“We did a several-months-long course, where we met with them weekly,” Hahn said. “Our wonderful regional chief of oncology, Farah Brasfield, MD, is heavily involved in the training. We provide education and knowledge, IT support and staff support to help these clinics become successful.”
Although tools such as the algorithm her team developed are important and valuable, clear communication and collaboration between patients and clinicians is much more essential, Hahn said.
“So much of it just comes down to the patient-physician relationship — whether it’s primary care or oncology,” Hahn told Healio. “All of our algorithms and risk stratifiers are wonderful but, without engaging our patients and clinicians, there’s no point to them. It comes down to that therapeutic alliance.”
Reference:
Hahn EE. Engaging primary care in survivorship. Presented at: Cancer Center Survivorship Research Forum, Sept. 11-12, 2023; Stanford, California.
For more information:
Erin E. Hahn, PhD, MPH, can be reached at Kaiser Permanente Department of Research & Evaluation, 100 S. Los Robles, Pasadena, CA 91101; email: erin.e.hahn@kp.org.
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Hahn EE. Engaging primary care in survivorship. Presented at: Cancer Center Survivorship Research Forum, Sept. 11-12, 2023; Stanford, California.
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