Minority of Oncologists and Primary Care Physicians Fully Discuss Survivorship Care Plans With Cancer Survivors
Of 53 National Cancer Institute cancer centers, only 43% report implementing survivorship care plans for at least some of their cancer survivors. In a study reported in the Journal of Clinical Oncology, Blanch-Hartigan et al found that a minority of a nationally representative sample of oncologists and primary care physicians routinely discuss all aspects of survivorship care or furnish survivorship care plans for cancer survivors.
Study Details
The study included data from the Survey of Physicians’ Attitudes Regarding the Care of Cancer Survivors (SPARCCS), a 2009 nationally representative mailed survey completed by 1,130 oncologists and 1,072 primary care physicians about practices and attitudes regarding post-treatment follow-up care for breast and colon cancer survivors. The absolute response rate for the survey was 57.5%, with responders not differing from nonresponders on any variables examined. Primary care physicians saw an average of 37 patients with breast or colon cancer per year, and oncologists saw an average of 35 such patients per week.
Frequency of Discussion
In total, 64% of oncologists reported always/almost always discussing survivorship care recommendations with survivors, 50% reported always/almost always discussing with survivors which physician would follow them for cancer care, 42% reported always/almost always discussing which physician would handle other medical issues, and 32% reported always/almost always discussing with survivors recommendations for survivorship care and provider responsibility for cancer and other medical follow-up. Only 10% reported always/almost always providing a written survivorship care plan to survivors, and 5% reported always/almost always giving survivors a written document and having discussions of survivorship recommendations and provider responsibility.
For primary care physicians, 21% reported always/almost always discussing recommendations for survivorship care with survivors, 34% reported always/almost always discussing with survivors which physician would follow them for their cancer, and 33% reported discussing which physician would handle other medical issues. Only 12% reported always/almost always discussing all three issues.
Factors Predicting Physician Involvement
Oncologists with detailed training in late and long-term effects of cancer were more likely to report always/almost always providing written survivorship are plans to survivors (odds ratio [OR] = 1.73, P = .002). Compared with white oncologists, Asian oncologists (OR = 2.75, P < .001) and oncologists of other racial/ethnic groups (OR = 2.69, P = .005) were both more likely to provide written survivorship care plans to survivors. Oncologists who reported that their patients requested more aggressive cancer surveillance or testing than they would recommend were less likely to provide written documents to survivors than oncologists who rarely or never experienced this problem (OR = 0.53, P = .007).
Oncologists with detailed training about late and long-term effects of cancer were more likely to always/almost always discuss recommendations and provider responsibilities with survivors than oncologists who received some or no training (OR = 2.02, P < .001). Oncologists who preferred a shared model of survivorship care (OR = 0.64, P = .040) and those who reported uncertainty about who should provide general preventive care (OR = 0.74, P = .040) were less likely to discuss recommendations and responsibilities for follow-up care. Asian oncologists were more likely than white oncologists to report always/almost always having these discussions with survivors (OR = 1.60, P = .008).
Primary care physicians who always/almost always received both a treatment summary and follow-up care plan from oncologists were > 9 times more likely to have discussions about survivorship care with survivors than those who did not always receive them (OR = 9.22, P < .001). Primary care physicians who reported inadequate knowledge or training to manage the problems of survivors were less likely (OR = 0.57, P = .035) to have these discussions.
Female primary care physicians were more likely than their male counterparts (OR = 2.03, P = .004) and older physicians were more likely than younger counterparts (OR = 1.04, P = .006) to have these discussions with survivors. In addition, primary care physicians who reported high vs low percentage of time spent in patient care (OR = 0.58, P = .040) and those who reported ≥ 35 vs 0 to 14 breast or colon cancer patients per year (OR = 0.54, P = .017) were less likely to have such discussions.
The investigators concluded, “A minority of both [primary care physicians] and oncologists reported consistently discussing and providing [survivorship care plans] to cancer survivors. Training and knowledge specific to survivorship care and coordinated care between [primary care physicians] and oncologists were associated with increased survivorship discussions with survivors. These nationally representative data provide a useful benchmark to assess implementation of new efforts to improve the follow-up care of survivors.”
Danielle Blanch-Hartigan, PhD, MPH, of the Office of Cancer Survivorship, National Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the National Cancer Institute and American Cancer Society Behavioral Research Center. The authors indicated no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
