Care of Cancer Survivors Often Falls Short
Most cancer patients enter survivorship with little direction from oncologists or primary care providers, according to a national survey.
Two-thirds of 1,130 oncologists said they always or almost always discuss survivorship with patients, but only a third told patients where to seek cancer-related or other care. Fewer than 5% of oncology respondents provided patients with a written plan for survivorship care.
Of 1,020 primary care providers surveyed, 12% reported regular discussions about recommendations for survivorship care or provider responsibility, as reported online in the Journal of Clinical Oncology.
“The nationally representative provider-reported data suggest that oncologists rarely reported consistently providing written survivorship care plans to survivors and that oncologists and primary care providers often failed to discuss survivorship care recommendations and delineation of provider responsibility for follow-up care with survivors,” Danielle Blanch-Hartigan, PhD, of the National Cancer Institute (NCI) in Bethesda, Md., and colleagues concluded.
“These data provide a useful benchmark to assess implementation of new mandates affecting the care of cancer survivors. The next step is to develop intervention studies to test the hypothesis that improved care coordination and enhanced physician survivorship training will increase the frequency of survivorship care discussions and downstream consequences.”
Improved cancer care has led to a growing population of cancer survivors, currently estimated at about 14 million Americans. Cancer survivors often have unique healthcare needs, including preventive care and ongoing management of chronic physical or psychosocial effects of treatment or comorbid conditions, the authors noted.
The Institute of Medicine has recommended that all cancer survivors receive a survivorship care plan after completing primary treatment. The recommended plan should include a written treatment summary and individualized follow-up plan from the patient’s oncologist.
The IOM report on survivorship further suggests discussions with cancer survivors about recommendations for care and delineation of responsibility for a patient’s ongoing care between oncology and primary care providers. Beginning next year, the American College of Surgeons Commission on Cancer will require a written survivorship care plan for every survivor after completion of primary treatment.
Despite the recommendations and presumed value of survivorship care plans, oncology providers have been slow to adopt the recommended practices. For example, a survey of 53 NCI cancer centers showed that fewer than half had implemented survivorship care plans for some or all patients.
Other studies have shown that most cancer survivors report not receiving a treatment summary, and more than 40% did not receive written follow-up instructions, the authors continued.
To obtain contemporary information about providers’ adherence to survivorship care recommendations, Blanch-Hartigan and colleagues analyzed data from the Survey of Physicians’ Attitudes Regarding the Care of Cancer Survivors (SPARCCS). Conducted in 2009, SPARCCS assimilated data provided by 1,130 oncologists and 1,072 primary care physicians about practices related to cancer survivorship care.
Investigators excluded responses from 51 primary care physicians who reported never having cared for a survivor of breast or colorectal cancer and from one who reported working outside of primary care.
The results showed that 64% of the oncologists reported always or almost always discussing survivorship care with patients after completion of primary cancer treatment. Half said they usually discussed which physician would provide follow-up for most of the patients’ cancer care, and 42.2% said they discussed which physician would take care of other medical issues.
The survey data showed that 31.7% of oncologists regularly discussed with cancer survivors recommendations for survivorship care and provider responsibility for cancer and other medical follow-up. Fewer than 10% of the oncologists routinely provided a written survivorship care plan, and 4.8% said they usually provided a written document and discussed survivorship recommendations and provider responsibility.
Among primary care providers, 21% routinely discussed recommendations for survivorship care; 34% said they always or almost always discussed which physician would provide follow-up for cancer; and 33% regularly discussed which physician will provide for other medical care. The investigators found that 12% of the providers routinely discussed all three items.
Analysis of factors associated with discussion of survivorship care and providing a written plan showed that oncologists were more likely to follow recommendations if they had received detailed training regarding late and long-term effects of cancer. Primary care providers were nine times more likely to follow recommendations when they received a treatment summary and follow-up care plan from patients’ oncologists.