Differences Between Primary Care Physicians’ and Oncologists’ Knowledge, Attitudes and Practices Regarding the Care of Cancer Survivors
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The growing number of cancer survivors combined with a looming shortage of oncology specialists will require greater coordination of post-treatment care responsibilities between oncologists and primary care physicians (PCPs). However, data are limited regarding these physicians’ views of cancer survivors’ care.
To compare PCPs and oncologists with regard to their knowledge, attitudes, and practices for follow-up care of breast and colon cancer survivors.
Design and Subjects
Mailed questionnaires were completed by a nationally representative sample of 1,072 PCPs and 1,130 medical oncologists in 2009 (cooperation rate = 65%). Sampling and non-response weights were used to calculate estimates to reflect practicing US PCPs and oncologists.
PCPs and oncologists reported their 1) preferred model for delivering cancer survivors’ care; 2) assessment of PCPs’ ability to perform follow-up care tasks; 3) confidence in their knowledge; and 4) cancer surveillance practices.
Compared with PCPs, oncologists were less likely to believe PCPs had the skills to conduct appropriate testing for breast cancer recurrence (59% vs. 23%, P < 0.001) or to care for late effects of breast cancer (75% vs. 38%, P < 0.001). Only 40% of PCPs were very confident of their own knowledge of testing for recurrence. PCPs were more likely than oncologists to endorse routine use of non-recommended blood and imaging tests for detecting cancer recurrence, with both groups departing substantially from guideline recommendations.
There are significant differences in PCPs’ and oncologists’ knowledge, attitudes, and practices with respect to care of cancer survivors. Improving cancer survivors’ care may require more effective communication between these two groups to increase PCPs’ confidence in their knowledge, and must also address oncologists’ attitudes regarding PCPs’ ability to care for cancer survivors.
- Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73. CrossRef
- Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: Lost in transition. Washington: Institute of Medicine, National Academies Press; 2005.
- Warren JL, Mariotto AB, Meekins A, Topor M, Brown ML. Current and future utilization of services from medical oncologists. J Clin Oncol. 2008;26:3242–47. CrossRef
- Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract. 2007;3:79–86. CrossRef
- Salsberg E, Grover A. Physician workforce shortages: implications and issues for academic health centers and policymakers. Acad Med. 2006;81:782–87. CrossRef
- Starfield B, Fryer GE Jr. The primary care physician workforce: ethical and policy implications. Ann Fam Med. 2007;5:486–91. CrossRef
- Shulman LN, Jacobs LA, Greenfield S, Jones B, McCabe MS, Syrjala K, et al. Cancer Care and Cancer Survivorship Care in the United States: Will We Be Able to Care for These Patients in the Future? J Oncol Pract. 2009;5:119–23. CrossRef
- Bunnell CA. Will We Be Able to Care For Cancer Patients In The Future? Oncology. 2011;24:1–9.
- Field TS, Doubeni C, Fox MP, Buist DS, Wei F, Geiger AM, et al. Under utilization of surveillance mammography among older breast cancer survivors. J Gen Intern Med. 2008;23:158–63. CrossRef
- Keating NL, Landrum MB, Guadagnoli E, Winer EP, Ayanian JZ. Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol. 2006;24:85–94. CrossRef
- Keating NL, Landrum MB, Guadagnoli E, Winer EP, Ayanian JZ. Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol. 2007;25:1074–81. CrossRef
- Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol. 2008;26:1073–79. CrossRef
- Pollack LA, Adamache W, Ryerson AB, Eheman CR, Richardson LC. Care of long-term cancer survivors: physicians seen by Medicare enrollees surviving longer than 5 years. Cancer. 2009;115:5284–95. CrossRef
- Cooper GS, Kou TD, Reynolds HL Jr. Receipt of guideline-recommended follow-up in older colorectal cancer survivors: a population-based analysis. Cancer. 2008;113:2029–37. CrossRef
- Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol. 2009;27:2489–95. CrossRef
- Grunfeld E, Levine MN, Julian JA, Coyle D, Szechtman B, Mirsky D, et al. Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol. 2006;24:848–55. CrossRef
- Grunfeld E. Primary care physicians and oncologists are players on the same team. J Clin Oncol. 2008;26:2246–47. CrossRef
- Haggstrom DA, Arora NK, Helft P, Clayman ML, Oakley-Girvan I. Follow-up care delivery among colorectal cancer survivors most often seen by primary and subspecialty care physicians. J Gen Intern Med. 2009;24(Suppl 2):S472–S479. CrossRef
- Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr. 2010;2010:11–17. CrossRef
- Debono D. Coping with the oncology workforce shortage: transitioning oncology follow-up care to primary care providers. J Oncol Pract. 2010;6:203–5. CrossRef
- Oeffinger KC, McCabe MS. Models for delivering survivorship care. J Clin Oncol. 2006;24:5117–24. CrossRef
- Ferrell BR, Winn R. Medical and nursing education and training opportunities to improve survivorship care. J Clin Oncol. 2006;24:5142–48. CrossRef
- Grant M, Economou D, Ferrell BR. Oncology nurse participation in survivorship care. Clin J Oncol Nurs. 2010;14:709–15. CrossRef
- Earle CC, Grunfeld E, Coyle D, Cripps MC, Stern HS. Cancer physicians' attitudes toward colorectal cancer follow-up. Ann Oncol. 2003;14:400–405. CrossRef
- Nissen MJ, Beran MS, Lee MW, Mehta SR, Pine DA, Swenson KK. Views of primary care providers on follow-up care of cancer patients. Fam Med. 2007;39:477–82.
- Del Giudice ME, Grunfeld E, Harvey BJ, Piliotis E, Verma S. Primary care physicians' views of routine follow-up care of cancer survivors. J Clin Oncol. 2009;27:3338–45. CrossRef
- Brazil K, Sussman J, Bainbridge D, Whelan T. Who is responsible? The role of family physicians in the provision of supportive cancer care. J Oncol Pract. 2010;6:19–24. CrossRef
- Cheung WY, Neville BA, Earle CC. Associations among cancer survivorship discussions, patient and physician expectations, and receipt of follow-up care. J Clin Oncol. 2010;28:2577–83. CrossRef
- Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, Warren L. Linking physician characteristics and Medicare claims data: issues in data availability, quality, and measurement. Med Care. 2002;40:IV–95. CrossRef
- Cherkin D, Lawrence D. An evaluation of the American Medical Association's Physician masterfile as a data source–one state's experience. Med Care. 1977;15:767–69. CrossRef
- Standard definitions: final dispositions of case codes and outcome rates for surveys. 6th edition. 2009. American Association for Public Opinion Research.
- Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24:5091–97. CrossRef
- Desch CE, Benson AB III, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;23:8512–19. CrossRef
- Klabunde CN, Frame PS, Meadow A, Jones E, Nadel M, Vernon SW. A national survey of primary care physicians' colorectal cancer screening recommendations and practices. Prev Med. 2003;36:352–62. CrossRef
- Klabunde CN, Lanier D, Nadel MR, McLeod C, Yuan G, Vernon SW. Colorectal cancer screening by primary care physicians: recommendations and practices, 2006–2007. Am J Prev Med. 2009;37:8–16. CrossRef
- Keating NL, Landrum MB, Rogers SO Jr, Baum SK, Virnig BA, Huskamp HA, et al. Physician factors associated with discussions about end-of-life care. Cancer. 2010;116:998–1006. CrossRef
- Klabunde CN, Ambs A, Keating NL, He Y, Doucette WR, Tisnado D, et al. The role of primary care physicians in cancer care. J Gen Intern Med. 2009;24:1029–36. CrossRef
- Mandelblatt JS, Berg CD, Meropol NJ, Edge SB, Gold K, Hwang YT, et al. Measuring and predicting surgeons' practice styles for breast cancer treatment in older women. Med Care. 2001;39:228–42. CrossRef
- Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, et al. Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004;141:771–80.
- Yeazel MW, Lindstrom Bremer KM, Center BA. A validated tool for gaining insight into clinicians' preventive medicine behaviors and beliefs: the preventive medicine attitudes and activities questionnaire (PMAAQ). Prev Med. 2006;43:86–91. CrossRef
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology™. Breast Cancer Guidelines, Version 2.2008. 2008.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology™. Colon Cancer Guidelines, Version 2.2011. 1-1-2010.
- Shapiro CL, McCabe MS, Syrjala KL, Friedman D, Jacobs LA, Ganz PA, et al. The LIVESTRONG Survivorship Center of Excellence Network. J Cancer Surviv. 2009;3:4–11. CrossRef
- Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010:25–30. CrossRef
- Hewitt M, Ganz PA. Implementing Cancer Survivorship Care Planning: Workshop Summary. Washington: Institute of Medicine, National Academies Press; 2007.
- Grunfeld E. Cancer survivorship: a challenge for primary care physicians. Br J Gen Pract. 2005;55:741–42.
- Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84. CrossRef
- Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;363:1–4. CrossRef
- Lauer MS. Elements of danger–the case of medical imaging. N Engl J Med. 2009;361:841–43. CrossRef
- Watson EK, Sugden EM, Rose PW. Views of primary care physicians and oncologists on cancer follow-up initiatives in primary care: an online survey. J Cancer Surviv. 2010;4:159–66. CrossRef
- Grunfeld E, Mant D, Yudkin P, Adewuyi-Dalton R, Cole D, Stewart J, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996;313:665–69. CrossRef
- Grunfeld E, Fitzpatrick R, Mant D, Yudkin P, Adewuyi-Dalton R, Stewart J, et al. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Pract. 1999;49:705–10.
- Differences Between Primary Care Physicians’ and Oncologists’ Knowledge, Attitudes and Practices Regarding the Care of Cancer Survivors
Journal of General Internal Medicine
Volume 26, Issue 12 , pp 1403-1410
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cancer care
- cancer survivorship
- physician survey
- physician attitudes
- Industry Sectors
- Author Affiliations
- 1. Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, 3300 Whitehaven St. NW Suite 4100, Washington, DC, 20007, USA
- 2. Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
- 3. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- 4. Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- 5. Behavioral Research Center, Intramural Research Department, American Cancer Society, Atlanta, GA, USA
- 6. National Institute of Nursing Research, Bethesda, MD, USA
- 7. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- 8. Division of General Medicine, Brigham and Women’s Hospital; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- 9. Schools of Public Health and Medicine, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- 10. Rollins School of Public Health, Emory University, Atlanta, GA, USA