We established the Primary Care for Cancer Survivor (PCCS) Clinic in 2015 to address transition and care delivery challenges unique to cancer survivors. We describe the clinical program, detail patients from the first 4 years of implementation, and discuss lessons learned during the process.
We abstracted relevant patient information from the electronic medical record, administered a needs assessment survey at initial visits, and collected relative value unit (RVU) data.
Between August 2015 and May 2019, we saw 230 PCCS patients with an increasing number of referrals yearly; nearly half were breast cancer survivors. At the initial visit, patients reported a median of 9 needs, with emotional needs most prevalent; over a third received at least one referral. PCCS patients generated higher billing codes and average RVUs compared with general patients.
In its first 4 years, the PCCS program has thrived as a unique model of cancer survivorship centered in primary care. PCCS patients reported numerous needs, emphasizing the critical need for a multi-disciplinary approach in this population. With increasing referrals, we have considered different risk stratification and staffing models for capacity and expansion. By generating more RVUs per visit compared with the general clinic, PCCS has demonstrated financial sustainability. Buy-in from our oncology colleagues, divisional support from general medicine, along with our collaboration of like-minded internists have allowed us to be a robust program.
Implications for Cancer Survivors
Models of survivorship care embedded in primary care can provide meaningful, patient-centered care for cancer survivors.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in translation. Washington, DC: National Academies Press.
Snyder CF, Frick KD, Kantsiper ME, Peairs KS, Herbert RJ, Blackford AL, et al. Prevention, screening, and surveillance care for breast cancer survivors compared with controls: changes from 1998 to 2002. J Clin Oncol : Off J Am Soc Clin Oncol. 2009;27(7):1054–61.
Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer. 2004;101(8):1712–9.
Nekhlyudov L, O’Malley DM, Hudson SV. Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities. Lancet Oncol. 2017;18(1):e30–8.
Rubinstein EB, Miller WL, Hudson SV, Howard J, O’Malley D, Tsui J, et al. Cancer survivorship care in advanced primary care practices: a qualitative study of challenges and opportunities. JAMA Intern Med. 2017;177(12):1726–32.
O’Malley D, Hudson SV, Nekhlyudov L, Howard J, Rubinstein E, Lee HS, et al. Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care. J Cancer Survivorship : Res Pract. 2017;11(1):13–23.
Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. Models of cancer survivorship care: overview and summary of current evidence. J Oncol Pract. 2015;11(1):e19–27.
Ness S, Kokal J, Fee-Schroeder K, Novotny P, Satele D, Barton D. Concerns across the survivorship trajectory: results from a survey of cancer survivors. Oncol Nurs Forum. 2013;40(1):35–42.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
Tan SY, Turner J, Kerin-Ayres K, Butler S, Deguchi C, Khatri S, Mo C, Warby A, Cunningham I, Malalasekera A et al: Health concerns of cancer survivors after primary anti-cancer treatment. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2019.
We thank Candace Nigrin and Amanda Bertram for their respective clinical and research support. We are grateful to Jamison Kies for her assistance with additional data support. We would like to acknowledge the Merck Foundation and our philanthropic benefactors for their financial support of our research efforts.
This work was financially supported by the Merck Foundation (grant number N022890).
Conflict of interest
Dr. Kimberly Peairs has received salary support from the Merck Foundation grant. Dr. Craig Pollack owns stock in Gilead Pharmaceuticals. The other authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Choi, Y., Radhakrishnan, A., Mahabare, D. et al. The Johns Hopkins Primary Care for Cancer Survivor Clinic: lessons learned in our first 4 years. J Cancer Surviv 14, 19–25 (2020). https://doi.org/10.1007/s11764-019-00816-3
- Cancer survivors
- Primary care
- Continuity of patient care