With 12 million cancer survivors in the United States and looming shortages of oncologists and PCPs [primary care physicians], the needs of cancer survivors can fall through the cracks,” stated Katherine S. Virgo, PhD, MBA, director of health services research at the American Cancer Society, during a presentation at the 2011 annual meeting of the American Society of Clinical Oncology. “We need to develop systems to ensure that survivors have continuity of care, monitoring for long-term effects of treatments, surveillance for the development of more cancers, psychosocial support, and treatment for comorbid conditions.”
What these systems will be and who will deliver which aspects of care are the challenges. A firstof- its-kind study aimed to identify physician beliefs, knowledge, attitudes, and practices regarding survivorship care. The Survey of Physician Attitudes Regarding the Care of Cancer Survivors, sponsored by the American Cancer Society and the National Cancer Institute, focused on those aspects of care for breast and colon cancer survivors.What it found was role confusion.
Medical oncologists and PCPs perceive different physician-based barriers to follow-up care. Medical oncologists are mainly concerned about duplication of care and uncertainty regarding responsibility for general preventive care for survivors. PCPs are more concerned about ordering tests/treatments to protect against malpractice suits, missed care, and the lack of adequate training to provide good survivorship care.
In total, 3596 physician members of the American Medical Association were asked: “In your practice, how often do you encounter the following problems when caring for breast or colon cancer survivors who completed active treatment over the past 5 years or more?
- Ordering tests or treatments as malpractice prevention
- Uncertainty regarding preventive healthcare responsibility
- Concerns regarding possible duplicated care
- Concerns regarding possible missed care
- Lack of adequate knowledge/training.
Physician specialty was associated significantly with all 5 barriers assessed. When responses were adjusted according to physician and practice characteristics, medical oncologists (1130 respondents) were less likely to report a lack of adequate knowledge/training than PCPs (1072 respondents). Medical oncologists also were less likely to order extra tests as malpractice protection and more likely to report uncertainty about general practice care responsibility. The latter was the most striking difference between the 2 specialties found in the survey.
“Education and survivorship care plans may be necessary to alleviate barriers due to inadequate training, malpractice-driven ordering of tests or treatments, and confusion regarding responsibility for general preventive care,” Virgo stated.
“We need optimal training for care of survivors. The National Comprehensive Cancer Network Guidelines for the major cancer types include sections on survivorship care that can help us be wise stewards of our diminishing healthcare funds,” stated Mark G. Kris, MD, chair of the thoracic service at Memorial Sloan- Kettering Cancer Center in New York City. “We should use money where it will yield the best benefits. Many hospitals have developed survivorship programs.”