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Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists

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Abstract

Purpose

New strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models.

Methods

The survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models.

Results

Of 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p < 0.001). Less than a quarter of PCPs and oncologists preferred specialized survivor clinics. A significant proportion of oncologists (87 %) did not feel that PCPs should take on the primary role of cancer follow-up. Most PCPs believed that they were better able to perform breast and colorectal cancer follow-up (57 %), detect recurrent cancers (74 %), and offer psychosocial support (50 %), but only a minority (32 %) was willing to assume primary responsibility. PCPs already involved with cancer surveillance (43 %) were more likely to prefer a PCP/shared care than oncologist-based survivorship model (OR, 2.08; 95 % CI, 1.34–3.23).

Conclusions and Implications for Cancer Survivors

PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer surveillance was one of the strongest predictors of PCPs’ willingness to assume this responsibility.

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References

  1. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010;19:1893–907.

    Article  PubMed  Google Scholar 

  2. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  3. Haugnes HS, Wethal T, Aass N, Dahl O, Klepp O, Langberg CW, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. J Clin Oncol. 2010;28:4649–57.

    Article  PubMed  Google Scholar 

  4. Hawkes AL, Lynch BM, Owen N, Aitken JF (2011) Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors. Eur J Cancer 47:267–276

    Google Scholar 

  5. Ganz PA. Survivorship: adult cancer survivors. Prim Care. 2009;36:721–41.

    Article  PubMed  Google Scholar 

  6. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol. 2006;24:5112–6.

    Article  PubMed  Google Scholar 

  7. Grunfeld E. Looking beyond survival: how are we looking at survivorship? J Clin Oncol. 2006;24:5166–9.

    Article  PubMed  Google Scholar 

  8. Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Committee on Cancer Survivorship, Improving Care and Quality of Life, National Cancer Policy Board, Institute of Medicine, and National Research Council. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  9. Ayanian JZ, Jacobsen PB. Enhancing research on cancer survivors. J Clin Oncol. 2006;24:5149–53.

    Article  PubMed  Google Scholar 

  10. Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev. 2011;20:1996–2005.

    Article  PubMed  Google Scholar 

  11. Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr. 2010;2010:11–7.

    Article  PubMed  Google Scholar 

  12. Sussman J, Baldwin LM. The interface of primary and oncology specialty care: from diagnosis through primary treatment. J Natl Cancer Inst Monogr. 2010;2010:18–24.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Potosky AL, Han PK, Rowland J, Klabunde CN, Smith T, Aziz N, et al. Differences between primary care physicians' and oncologists' knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med. 2011;26:1403–10.

    Article  PubMed  Google Scholar 

  15. National Cancer Institute (2010) Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS). Available from http://healthservices.cancer.gov/surveys/sparccs/. Accessed December 2010

  16. Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor's perspective. J Clin Oncol. 2011;29:1280–9.

    Article  PubMed  Google Scholar 

  17. 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;26:1073–9.

    Article  PubMed  Google Scholar 

  18. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med. 2008;23:254–9.

    Article  PubMed  Google Scholar 

  19. 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. 2009;27:1054–61.

    Article  PubMed  Google Scholar 

  20. Snyder CF, Frick KD, Peairs KS, Kantsiper ME, Herbert RJ, Blackford AL, et al. Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study. J Gen Intern Med. 2009;24:469–74.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Jacobs LA, Palmer SC, Schwartz LA, DeMichele A, Mao JJ, Carver J, et al. Adult cancer survivorship: evolution, research, and planning care. CA Cancer J Clin. 2009;59:391–410.

    Article  PubMed  Google Scholar 

  24. Houlihan NG. Transitioning to cancer survivorship: plans of care. Oncology (Williston Park). 2009;23:42–8.

    Google Scholar 

  25. Ganz PA, Casillas J, Hahn EE. Ensuring quality care for cancer survivors: implementing the survivorship care plan. Semin Oncol Nurs. 2008;24:208–17.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. Warren JL, Mariotto AB, Meekins A, Topor M, Brown ML. Current and future utilization of services from medical oncologists. J Clin Oncol. 2008;26:3242–7.

    Article  PubMed  Google Scholar 

  29. Debono D. Coping with the oncology workforce shortage: transitioning oncology follow-up care to primary care providers. J Oncol Pract. 2010;6:203–5.

    Article  PubMed  Google Scholar 

  30. Frew G, Smith A, Zutshi B, Young N, Aggarwal A, Jones P, et al. Results of a quantitative survey to explore both perceptions of the purposes of follow-up and preferences for methods of follow-up delivery among service users, primary care practitioners and specialist clinicians after cancer treatment. Clin Oncol (R Coll Radiol). 2010;22:874–84.

    Article  CAS  Google Scholar 

  31. Earle CC, Chretien Y, Morris C, Ayanian JZ, Keating NL, Polgreen LA, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol. 2010;28:1700–5.

    Article  PubMed  Google Scholar 

  32. Casillas J, Castellino SM, Hudson MM, Mertens AC, Lima IS, Liu Q, et al. Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS). Cancer. 2011;117:1966–75.

    Article  PubMed  Google Scholar 

  33. Shi Q, Smith TG, Michonski JD, Stein KD, Kaw C, Cleeland CS. Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors. Cancer. 2011;117:2779–90.

    Article  PubMed  Google Scholar 

  34. Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC. Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med. 2009;24 Suppl 2:S459–66.

    Article  PubMed  Google Scholar 

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Financial disclosure

None

Funding

National Cancer Institute HHSN261201000316C and intramural support from the American Cancer Society

Author information

Authors and Affiliations

  1. Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada

    Winson Y. Cheung

  2. Office of Extramural Programs, Division of Extramural Activities, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA

    Noreen Aziz

  3. Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Anne-Michelle Noone

  4. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Julia H. Rowland

  5. Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA

    Arnold L. Potosky

  6. Division of General Medicine, Brigham and Women’s Hospital and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    John Z. Ayanian

  7. Health Services Research Program, Intramural Research Department, American Cancer Society, Atlanta, GA, USA

    Katherine S. Virgo

  8. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Katherine S. Virgo & Michael Stefanek

  9. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine and Public Health, Los Angeles, CA, USA

    Patricia A. Ganz

  10. Ontario Institute for Cancer Research, Toronto, Canada

    Craig C. Earle

  11. Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, G Wing 106, Toronto, ON, M4N 3M5, Canada

    Craig C. Earle

Authors
  1. Winson Y. Cheung
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  2. Noreen Aziz
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  3. Anne-Michelle Noone
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  4. Julia H. Rowland
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  5. Arnold L. Potosky
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  6. John Z. Ayanian
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  7. Katherine S. Virgo
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  8. Patricia A. Ganz
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  9. Michael Stefanek
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  10. Craig C. Earle
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Corresponding author

Correspondence to Craig C. Earle.

Appendix

Appendix

Fig. 4
figure 4

Physician preferences for different models of cancer survivorship care. N (center of bar) is based on the number of survey respondents and percents are weighted to the US population of physicians. †p values are calculated using Chi-square tests based on weighted counts. Double dagger, includes clinics operated by nonphysician providers such as physician assistants

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Cheung, W.Y., Aziz, N., Noone, AM. et al. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 7, 343–354 (2013). https://doi.org/10.1007/s11764-013-0281-y

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  • DOI: https://doi.org/10.1007/s11764-013-0281-y

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