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

  • David A. Haggstrom
  • Neeraj K. Arora
  • Paul Helft
  • Marla L. Clayman
  • Ingrid Oakley-Girvan
Original Article

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 

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • David A. Haggstrom
    • 1
    • 2
    • 3
    • 4
  • Neeraj K. Arora
    • 5
  • Paul Helft
    • 4
    • 6
    • 7
    • 8
  • Marla L. Clayman
    • 9
    • 10
  • Ingrid Oakley-Girvan
    • 11
  1. 1.VA Health Services Research & Development (HSR&D) Center on Implementing Evidence-based Practice (CIEBP)Richard L. Roudebush VA Medical CenterIndianapolisUSA
  2. 2.IU Center for Health Services and Outcomes Research (CHSOR)Regenstrief Institute, Inc.IndianapolisUSA
  3. 3.Division of General Internal Medicine and Geriatrics, Department of MedicineIndiana University School of Medicine (IUSM)IndianapolisUSA
  4. 4.Indiana University Simon Cancer CenterIndianapolisUSA
  5. 5.Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  6. 6.Division of Hematology/Oncology, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  7. 7.The Charles Warren Fairbanks Center for Medical EthicsClarian Health, Inc.IndianapolisUSA
  8. 8.The Indiana University Center for Bioethics, Indiana UniversityIndianapolisUSA
  9. 9.Division of General Internal MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  10. 10.Robert H. Lurie Comprehensive Cancer CenterChicagoUSA
  11. 11.Northern California Cancer CenterFremontUSA

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