Adult Cancer Survivors Discuss Follow-up in Primary Care: 'Not What I Want, But Maybe What I Need'

Purpose Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown. Methods A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. Results A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence. Conclusion With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.

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Primary care physician willingness to provide follow-up care for adult cancer survivors

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6562 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6562-6562

Author(s):

M. Del Giudice ◽

S. Verma ◽

E. Piliotis ◽

B. J. Harvey ◽

E. Grunfeld

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Primary Care Physicians ◽

Psychosocial Support ◽

Patient Specific ◽

Optimal Care ◽

Adult Cancer Survivors ◽

Follow Up Care ◽

Cancer Specialists

6562 Background: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Due to a lack of evidence suggesting advantages of long-term follow-up care in oncology clinics, there is increasing support for the locus of this care to be provided by primary care physicians (PCPs). However, views from PCPs on this issue remain to be studied. Methods: A mail survey of a random sample of community based PCPs in Canada, stratified by region and proximity to urban centres was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. Results: 330 PCPs responded (adjusted response rate 52%). PCPs are willing to assume exclusive responsibility for routine follow-up care approximately 2.5 (95 % Confidence Interval [CI], 2.3–2.7;) years after active treatment of colorectal and prostate cancers; 2.8 (95 % CI, 2.5–3.1) years for breast cancer and 3.2 years (95% CI, 2.9–3.5) years for lymphoma. Respondents ranked care shared between cancer specialists and PCPs as their preferred strategy of follow-up, followed equally by exclusive care by cancer specialists or by PCPs. PCPs considered the most useful modalities to assist them in assuming exclusive responsibility for follow-up care were: (1) a patient-specific letter from the specialist; (2) printed guidelines; (3) expedited routes of re-referral; and (4) expedited access to investigations for suspected recurrence. The least useful modalities were: (1) pamphlets; (2) more office staff; and (3) websites. The majority of PCPs recognized that specialist clinics are overcrowded (55.6 %) and that PCPs are better placed to provide psychosocial support (79.8 %). However, they believed that specialist follow-up is important so that patients remain in the cancer centre system (67.2 %) and that patients expect follow-up care by cancer specialists (71.7%). Variations in responses were observed according to current practices and proximity to urban centres. Conclusions: With appropriate information and support in place, PCPs are willing to assume exclusive responsibility for the follow-up care of prevalent adult cancer survivors. Insights gained from this survey may help guide strategies in providing optimal care to cancer survivors. No significant financial relationships to disclose.

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Young adult cancer survivors’ follow-up care expectations of oncologists and primary care physicians

Journal of Cancer Survivorship ◽

10.1007/s11764-016-0587-7 ◽

2016 ◽

Vol 11 (3) ◽

pp. 295-301 ◽

Cited By ~ 5

Author(s):

Kiara Hugh-Yeun ◽

Divjot Kumar ◽

Ali Moghaddamjou ◽

Jenny Y. Ruan ◽

Winson Y. Cheung

Keyword(s):

Primary Care ◽

Young Adult ◽

Cancer Survivors ◽

Primary Care Physicians ◽

Young Adult Cancer Survivors ◽

Adult Cancer Survivors ◽

Follow Up Care ◽

Young Adult Cancer

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Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

Current Oncology ◽

10.3390/curroncol28010004 ◽

2020 ◽

Vol 28 (1) ◽

pp. 13-25

Author(s):

Soleil Chahine ◽

Gordon Walsh ◽

Robin Urquhart

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Cancer Survivors ◽

Sociodemographic Factors ◽

Patient Navigator ◽

Care Providers ◽

Psychosocial Needs ◽

Factors Associated ◽

Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

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Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

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Follow-up strategies following completion of primary cancer treatment in adult cancer survivors

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012425 ◽

2016 ◽

Cited By ~ 2

Author(s):

Beverley Lim Høeg ◽

Pernille Envold Bidstrup ◽

Trine Allerslev Horsboel ◽

Susanne Oksbjerg Dalton ◽

Lena Saltbaek ◽

...

Keyword(s):

Cancer Survivors ◽

Cancer Treatment ◽

Primary Cancer ◽

Adult Cancer Survivors

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Improving service delivery to cancer survivors in primary care settings project.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.52 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 52-52

Author(s):

Lewis E. Foxhall

Keyword(s):

Primary Care ◽

Colon Cancer ◽

Cancer Survivors ◽

Care Management ◽

Survivorship Care ◽

Behavioral Counseling ◽

Colon Cancers ◽

Screening And Prevention

52 Background: An estimated 14 million cancer survivors live in the U.S., with up to 18 million expected by 2020. Methods: We established a partnership with three Texas family medicine training programs to provide interactive educational sessions focused on survivors’ needs for primary prevention and lifestyle counseling, surveillance and screening, and prevention of psychosocial and long-term effects. Surveys assessing resident and PCP knowledge, self-efficacy, and practices regarding survivorship care management were administered through REDCap in July 2016 and 2017. Results: Baseline response rates were 64% (60/94) and 59% (55/93) at follow-up. Compared to baseline, providers at follow-up were significantly more likely to report being “very confident” in their knowledge about: appropriate surveillance to detect recurrent breast cancer (5% vs 24%; p = 0.01); long-term physical effects of colon cancer and its treatment (8% vs 18%; p = 0.04); potential adverse psychosocial outcomes of colon cancer treatment (24% vs 44%; p = 0.01); appropriate screening for new primary breast (29% vs 61%; p < 0.001) and colon cancers (27% vs 51%; p = 0.01); and preventive lifestyle/behavioral counseling for breast (39% vs 59%; p = 0.03) and colon cancers (37% vs 59%; p = 0.01). Participants were also more likely to “strongly agree” that they have the skills necessary to: provide follow-up care related to the colon cancer and its treatment (10% vs 28%; p = 0.02); initiate appropriate screening for other new primary cancers for breast (28% vs 56%; p < 0.01) and colon cancer survivors (28% vs 58%; p < 0.01); and conduct lifestyle/behavioral counseling to prevent cancer for breast (33% vs 53%; p = 0.03) and colon cancer survivors (34% vs 55%; p = 0.02). Conclusions: Preliminary results suggest our project has improved provider knowledge, self-efficacy, and practices regarding survivorship care management, with the highest levels in areas pertaining to screening and prevention. We aim to continue this trajectory of improvement in subsequent project years and disseminate the project to other primary care training sites in Texas and beyond.

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