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PCPs have opportunity to support patients in cancer treatment decisions
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Primary care physicians often feel ill-equipped to discuss treatment options with patients with breast cancer, according to a survey published in Cancer, but by collaborating with oncologists, they have a unique opportunity to help support patients in their decisions.
Multiple oncologists are often involved in treatment decisions for patients with early-stage breast cancer, but while previous research has suggested that one-third of patients with breast cancer have consulted their PCP about treatment options, it is unknown how involved PCPs are in these decisions, according to Lauren P. Wallner, PhD, MPH, a health services researcher at the University of Michigan Rogel Cancer Center, and colleagues.
Wallner and colleagues surveyed 517 PCPs caring for 1,077 women with early-stage breast cancer about how often they discussed surgery, radiation or chemotherapy options with their patients, their comfort level in discussing these issues and their confidence in their knowledge to help with treatment decisions.
The survey revealed that 34% of PCPs discussed surgery, 23% discussed radiation and 22% discussed chemotherapy options with their patients.
Of the PCPs who were involved in surgical decisions, 22% reported that they did not feel comfortable discussing the decision and 17% felt like they did not have the essential knowledge to participate in treatment decision making. These results were similar for discussions about radiation and chemotherapy decisions.
PCPs with more confidence and comfort in their ability to participate in decision making had higher odds of participating in decisions for surgery (OR = 6.01; 95% CI, 4.16-8.68), radiation (OR = 8.37; 95% CI, 5.16-13.58) and chemotherapy (OR = 6.56; 95% CI, 4.23-10.17).
“PCPs may be involved in cancer care earlier than we thought,” Wallner said in a press release. “If we are going to promote their involvement, we may need to start doing that earlier, around the time of initial treatment, and ensure PCPs have the information they need to effectively participate in the decision-making process.”
Healio Primary Care Today spoke with Wallner to uncover how PCPs fit into cancer treatment decisions. – by Alaina Tedesco
Question: What is the PCP’s role in helping patients make cancer treatment decisions?
Answer: The exact role of PCPs in helping patients with cancer treatment decision making is still unclear. But PCPs may have the opportunity with some patients to support them during this difficult and often chaotic time, and help them engage in shared decision making when appropriate.
Q: What can PCPs do to be more prepared for cancer treatment discussions?
A: This is a challenge in the era of rapidly evolving cancer treatment guidelines and the increasing time demands on PCPs to manage many aspects of patients’ care. Improving the communication between the treating oncologist and the PCP either at diagnosis or during treatment may help facilitate PCP engagement during this time and give them the opportunity to help support the patient as needed.
Q: What are the best methods to discuss cancer treatments?
A: In the context of early-stage breast cancer, where multiple treatments exist that result in comparable outcomes, shared decision making is the recommended approach. This collaborative process takes into accounts patients’ values and preferences.
Q: What breast cancer treatments do PCPs need to know?
A: Because of the rapidly changing treatment landscape and limited time PCPs already have to address all of their patients’ health care needs, keeping up to date on treatment guidelines is probably not feasible. Better communication between the oncologist and the PCP about the treatment strategies may be a more feasible strategy to engage PCPs as needed during treatment.
Reference:
Wallner LP, et al. Cancer. 2019;doi:10.1002/cncr.31998.
Disclosures: Wallner reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.