Better Information Needed for Primary Care Providers Who Treat Cancer Survivors

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Many primary care providers are unaware of the late effects of chemotherapy, according to survey results presented at the ASCO Annual Meeting.1 For three out of four commonly used chemotherapy agents, medical oncologists performed well on the survey, but 29% to 38% of medical oncologists were unable to correctly identify two possible late side effects of cyclophosphamide.

Problem Created by Success

“Oncologists often identified late effects of commonly used chemotherapy, while primary care providers did not,” said lead author Larissa ­Nekhlyudov, MD, MPH, Associate Professor at Harvard Medical School and internist at Harvard Vanguard Medical Associates, Boston. “With more than 12 million cancer survivors, the transition from oncologists to primary care needs to be improved. Patients should be aware of the side effects of the drugs they receive, but it is vitally important that oncologists relay this information to patients’ primary care providers so their risks can be appropriately managed throughout their lives

 “In some sense, this study represents a positive message, because this is a problem [long-term survivorship] created by our successes,” said 2011–2012 ASCO President Michael P. Link, MD, Lydia J. Lee Professor of Pediatric Hematology/Oncology at Stanford University School of Medicine, Palo Alto, California. “Our patients return to primary care. Patients and primary care providers need summaries of their treatment history and guidelines for survivorship care. This situation makes a good case for electronic medical records. We need to make sure that the ball does not get dropped in the transition from oncologists’ offices to primary care providers.”

Knowledge Gap for Late Effects

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors was completed by 1,072 primary care providers and 1,130 medical oncologists who treat breast and colorectal cancers. Physicians were asked to select which of five late effects of four widely used cancer drugs—doxorubicin, paclitaxel, oxaliplatin, and cyclophosphamide—they had observed or seen reported.

For doxorubicin, 55% of primary care providers and 95% of medical oncologists correctly identified cardiac dysfunction as a late effect. For paclitaxel, 26% of primary care providers and 97% of medical oncologists correctly identified peripheral neuropathy as a late effect. For oxaliplatin, 22% of primary care providers and 96% of medical oncologists correctly identified peripheral neuropathy as a late effect.

The knowledge gap for late effects of cyclophosphamide was evident for oncologists as well; 15% of primary care providers and only 71% of medical oncologists correctly identified premature menopause as a late effect, and 17% of primary care providers and only 62% of medical oncologists correctly identified secondary malignancy as a late effect.

Only 6% of primary care providers and 65% of oncologists correctly identified the late effects of all four drugs. In an adjusted analysis, being board-certified in oncology and spending more time in patient care increased the likelihood of correctly identifying late effects of all four drugs.

Need for Improvement

“These findings emphasize the need for ongoing education among all physicians who care for cancer survivors about potential late effects. In the transition of patients from oncology to primary care settings, primary care providers should be informed about the late effects of cancer treatment so that they may be better prepared to recognize and address these effects among the cancer survivors in their care,” Dr. Nekhlyudov said. “Whether this may be achieved with the development and use of survivorship care plans needs to be evaluated,” she added. ■

Disclosure: Drs. Nekhlyudov and Link reported no potential conflicts of interest.


1. Nekhlyudov L, Aziz N, Lerro CC, Virgo K: Oncologists’ and primary care providers’ awareness of late effects of cancer treatment: Implications for survivorship care. 2012 ASCO Annual Meeting. Abstract 6008. Presented June 2, 2012.