Primary care physicians’ perspectives of the survivorship care for older breast cancer survivors: a pilot study
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To evaluate primary care physicians’ (PCPs) role in survivorship care of older breast cancer survivors, their experiences and opinions of survivorship care plans (SCPs), and suggestions for improving care coordination and facilitation of SCPs among older (≥ 65 years) breast cancer survivors.
A web-based questionnaire was completed individually by PCPs about their training and what areas of survivorship they address under their care. A subset of survey participants were interviewed about survivorship care, care coordination, and the appropriateness and effects of SCPs on older breast cancer survivors’ outcomes.
Physician participants (N = 29) had an average of 13.5 years in practice. PCPs surveyed that their main role was to provide general health promotion and their least common role was to manage late- and/or long-term effects. Semi-structured interviews indicated that the majority of PCPs did not receive a SCP from their patients’ oncologists and that communication regarding survivorship care was poor. Participants’ suggestions for improvements to SCPs and survivorship care included regular communication with oncologists, delegation from oncologists regarding roles, and mutual understanding of each other’s roles.
PCPs indicated that survivorship care and SCPs should be improved, regarding communication and roles related to their patients’ survivorship. PCPs should assume an active role to enhance PCP-oncologist communication. Future research in PCPs’ role in survivorship care in a broad, diverse cancer survivor population is warranted.
Implications for cancer survivors
More attention needs to focus on the importance of PCPs, as they are an integral part of dual management for older breast cancer survivors post-treatment.
KeywordsCancer survivorship Survivorship care plans Primary care physicians Care coordination Geriatrics
This study was financially supported by the Clinical and Translational Science Award (UL1TR001070) from the National Center for Advancing Translational Sciences.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Bluethmann SM, Mariotto AB, Rowland JH (2016) Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology 25(7):1029–1036Google Scholar
- 3.Faul LA, Luta G, Sheppard V, Isaacs C, Cohen HJ, Muss HB, Yung R, Clapp JD, Winer E, Hudis C, Tallarico M, Wang J, Barry WT, Mandelblatt JS (2014) Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Surviv 8(4):627–637CrossRefGoogle Scholar
- 5.Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED et al Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery. J Clin Oncol. 2018:Jco2018777482Google Scholar
- 8.Blanch-Hartigan D, Forsythe LP, Alfano CM, Smith T, Nekhlyudov L, Ganz PA, Rowland JH (2014) Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. J Clin Oncol 32(15):1578–1585CrossRefGoogle Scholar
- 10.Dittus KL, Sprague BL, Pace CM, Dulko DA, Pollack LA, Hawkins NA et al (2014) Primary care provider evaluation of cancer survivorship care plans developed for patients in their practice. J Gen Pract (Los Angeles) 2(4):163Google Scholar
- 11.Cheung WY, Aziz N, Noone AM, Rowland JH, Potosky AL, Ayanian JZ, Virgo KS, Ganz PA, Stefanek M, Earle CC (2013) Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 7(3):343–354CrossRefGoogle Scholar
- 12.Shen MJ, Binz-Scharf M, D'Agostino T, Blakeney N, Weiss E, Michaels M, Patel S, McKee MD, Bylund CL (2015) A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities. Cancer 121(6):908–915CrossRefGoogle Scholar
- 16.Haq R, Heus L, Baker NA, Dastur D, Leung FH, Leung E, Li B, Vu K, Parsons JA (2013) Designing a multifaceted survivorship care plan to meet the information and communication needs of breast cancer patients and their family physicians: results of a qualitative pilot study. BMC Med Informatics Decis Mak 13:76CrossRefGoogle Scholar
- 18.American College of Surgeons Commission on Cancer (2012) Cancer program standards 2012: ensuring patient-centered care. Chicago, ILGoogle Scholar
- 19.American Society of Clinical Oncology (2014) Survivorship care planning tools. Available from: https://www.asco.org/practice-guidelines/cancer-care-initiatives/prevention-survivorship/survivorship-compendium. Accessed 5 Dec 2018
- 20.Office of Cancer Communications NCI (2002) Making health communication programs work : a planner’s guide. U.S. Dept. of health and human services, public health service, National Institutes of Health, BethesdaGoogle Scholar
- 21.Hewitt M, Greenfield S, Stovall E (2006) From cancer patient to cancer survivor: lost in translation. Institute of Medicine, Washington, DCGoogle Scholar
- 22.Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American cancer society/American society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol 34(6):611–635CrossRefGoogle Scholar
- 31.Association of American Medical Colleges (2017) Physician specialty data reportGoogle Scholar
- 34.Donohue S, Haine JE, Li Z, Trowbridge ER, Kamnetz SA, Feldstein DA et al (2017) The impact of a primary care education program regarding cancer survivorship care plans: results from an engineering, primary care, and oncology collaborative for survivorship health. J Cancer EducGoogle Scholar
- 38.Baravelli C, Krishnasamy M, Pezaro C, Schofield P, Lotfi-Jam K, Rogers M, Milne D, Aranda S, King D, Shaw B, Grogan S, Jefford M (2009) The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up. J Cancer Surviv 3(2):99–108CrossRefGoogle Scholar