Adult Cancer Survivors Discuss Follow-up in Primary Care: 'Not What I Want, But Maybe What I Need'

The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
The Annals of Family Medicine (Impact Factor: 5.43). 09/2012; 10(5):418-27. DOI: 10.1370/afm.1379
Source: PubMed


BACKGROUND Nearly one-third of office visits for cancer are handled by primary care physicians. Yet, few studies examine patient perspectives on these physicians' roles in their cancer follow-up care or their care preferences. METHODS We explored survivor preferences through qualitative, semistructured, in-depth interviews drawing on patients recruited from 2 National Cancer Institute-designated comprehensive cancer centers and 6 community hospitals. We recruited a purposive sample of early-stage breast and prostate cancer survivors aged 47 to 80 years, stratified by age, race, and length of time from and location of cancer treatment. Survivors were at least 2 years beyond completion of their active cancer treatment RESULTS Forty-two survivors participated in the study. Most participants expressed strong preferences to receive follow-up care from their cancer specialists (52%). They described the following barriers to the primary care physician's engagement in follow-up care: (1) lack of cancer expertise, (2) limited or no involvement with original cancer care, and (3) lack of care continuity. Only one-third of participants (38%) believed there was a role for primary care in cancer follow-up care and suggested the following opportunities: (1) performing routine cancer-screening tests, (2) supplementing cancer and cancer-related specialist care, and (3) providing follow-up medical care when "enough time has passed" or the survivors felt that they could reintegrate into the noncancer population. CONCLUSION Survivors have concerns about seeing their primary care physician for cancer-related follow-up care. Research interventions to address these issues are necessary to enhance the quality of care received by cancer survivors.

Download full-text


Available from: Jeanne M Ferrante, Jun 11, 2014
  • Source
    • "The growing number of survivors is surpassing the capacity of cancer care systems, and those systems are unable to keep pace with demand, which places greater demand on primary care providers (PCPs). PCPs often lack sufficient knowledge about the individualized needs, risks, and surveillance plans for survivors (Hudson et al., 2012; Nekhlyudov, Aziz, Lerro, & Virgo, 2012) and for what they as PCPs are responsible for. This often is caused by poor interprofessional communication patterns and care coordination (Cheung, Neville, Cameron, Cook, & Earle, 2009; Earle, Burstein, Winer, & Weeks, 2003; Earle & Neville, 2004; Nissen et al., 2007; Snyder et al., 2008a, 2008b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The number of adult cancer survivors in the United States has exceeded 13 million and continues to rise, yet care for these survivors continues to be poorly coordinated and their needs remain inadequately addressed. As one solution to this growing problem, the Institute of Medicine in 2006 recommended the delivery of a survivorship care plan (SCP) to each patient completing active treatment. The American College of Surgeons Commission on Cancer subsequently published its Program Standard 3.3, requiring accredited programs to implement treatment summaries and SCPs by 2015, to help improve communication, quality, and coordination of care for cancer survivors. As practices and cancer centers around the country have undertaken SCP implementation efforts, myriad barriers to their preparation and delivery have emerged, with time and human resource burden top among these, in addition to a lack of proven outcomes. Fortunately, a growing number of publications document practical and feasible delivery models, and an increasingly robust body of research on stakeholder preferences is available to focus SCP implementation efforts.
    Clinical Journal of Oncology Nursing 02/2014; 18:15-22. DOI:10.1188/14.CJON.S1.15-22 · 0.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population. Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months. Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service. The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.
    The Journal of the American Board of Family Medicine 11/2013; 26(6):628-36. DOI:10.3122/jabfm.2013.06.120345 · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Survivor care plans have been described as useful tools for enhancing the quality of follow-up care that cancer survivors receive after their active treatment has been completed. The relative success of current survivor care plan models is strongly dependent on the actions of individual patients. In this qualitative study of 33 cancer survivors, we explored patients' understanding of follow-up care and their motivations and resources for seeking care. Three types of survivor experiences were identified from narratives of patients treated in community oncology and NCI designated comprehensive cancer centers, ranging from non-activated patients who need enhanced health care communication and decision support to navigate their care to highly activated patients adept at navigating complex health care settings. Using the Patient-Centered Medical Home as a conceptual framework, we propose a research, policy and practice agenda that advocates for multi-faceted decision support to enhance cancer survivorship and follow-up care.
    Translational Behavioral Medicine 09/2012; 2(3):322-331. DOI:10.1007/s13142-012-0138-3
Show more