Original Article

Journal of General Internal Medicine

, 24:472

First online:

Follow-up Care Delivery Among Colorectal Cancer Survivors Most Often Seen by Primary and Subspecialty Care Physicians

  • David A. HaggstromAffiliated withVA Health Services Research & Development (HSR&D) Center on Implementing Evidence-based Practice (CIEBP), Richard L. Roudebush VA Medical CenterIU Center for Health Services and Outcomes Research (CHSOR), Regenstrief Institute, Inc.Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine (IUSM)Indiana University Simon Cancer Center Email author 
  • , Neeraj K. AroraAffiliated withOutcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
  • , Paul HelftAffiliated withIndiana University Simon Cancer CenterDivision of Hematology/Oncology, Department of Medicine, Indiana University School of MedicineThe Charles Warren Fairbanks Center for Medical Ethics, Clarian Health, Inc.The Indiana University Center for Bioethics, Indiana University
  • , Marla L. ClaymanAffiliated withDivision of General Internal Medicine, Northwestern University Feinberg School of MedicineRobert H. Lurie Comprehensive Cancer Center
  • , Ingrid Oakley-GirvanAffiliated withNorthern California Cancer Center

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Abstract

Background

The Institute of Medicine has identified patients as a key source of information for assessing the quality of care.

Objective

To evaluate the association of physician specialty with the content and quality of follow-up cancer care.

Design and Participants

Three hundred three colorectal cancer (CRC) survivors in Northern California were surveyed 2–5 years post-diagnosis.

Measurements

Specialty of physician seen most often [primary care physician (PCP), oncologist, surgeon, or gastroenterologist]; other physician specialties seen; patient characteristics; content of visits; patient-centered quality of follow-up care (communication, coordination, nursing, and staff interactions).

Main Results

A minority (16%) of CRC survivors reported that the doctor they most often saw for follow-up cancer care was a PCP, while 60% saw an oncologist. Many CRC survivors (40%) saw >1 physician for follow-up cancer care. Survivors most often seen by PCPs were more likely to have three or more medical comorbidities (70% vs. 51%, p = 0.012) than survivors seen by subspecialty physicians. Survivors seen by PCPs were less likely to report seeing a doctor for medical tests and more likely to report discussing disease prevention (82% vs. 64%, p = 0.012) or diet (70% vs. 48%, p = 0.005) with their doctor. There were no significant specialty differences in patient-centered quality of follow-up cancer care.

Conclusions

Cancer survivors’ assessment of the quality of care was similar across specialties, while the content of follow-up cancer care varied by physician specialty. These findings provide important information about the potential value of primary care and the need for coordination when delivering care to CRC survivors.

KEY WORDS

cancer survivorship colorectal cancer primary care health services research quality assessment patient-centered care