Clinical Trial Participation Tied to Improved Breast Cancer Outcomes

['lizbeth]

Jackie,

Well I don't fall in love with my doctors . . . I'm paying them to be part of my professional health care team. I appreciate them for what they do to help me maintain good health.

I don't want my surgeons to monitor my oncologist, or my radiologists. Oncologists and radiologists are highly trained professionals who can make their own professional decisions on my behalf.

I would prefer surgeons to focus on improving surgery, and not take on the supervision of other areas. An alert system for surgeons to let them know if patients don't complete treatment in other areas - no thank you. Stay out of the decisions that should be left up to myself and other professionals.

The information is over 5 years old. The outcome of the study shows the principal investigator's biases.

I see strong signs that the industry is moving towards personalized medicine, away from always including chemo and radiation therapy. New science is starting to show that "compliance" in these areas is not necessary to have good results.

Dr Dooley and his associates should look for a more constructive way to spend research money.

[Jackie07]

Perhaps you are thinking about a general surgeon instead of a surgical oncologist. The following article (abstract) does call for additional research on care coordination and delivery.

J Cancer Surviv. 2013 Dec 19. [Epub ahead of print]
Perspectives of cancer survivors on the role of different healthcare providers in an integrated delivery system.
Chubak J, Aiello Bowles EJ, Tuzzio L, Ludman E, Rutter CM, Reid RJ, Wagner EH.
Author information
Abstract
PURPOSE:
The purpose of this paper is to describe patient perspectives on survivorship care 1 year after cancer diagnosis.
METHODS:
The study was conducted at an integrated healthcare delivery system in western Washington State. Participants were patients with breast, colorectal, and lung cancer who had enrolled in a randomized control trial (RCT) of oncology nurse navigation to improve early cancer care. Those alive and enrolled in the healthcare system 1 year after diagnosis were eligible for this analysis. Participants completed surveys by phone. Questions focused on receipt of treatment summaries and care plans; discussions with different providers; patient opinions on who does and should provide their care; and patient perspectives primary care providers' (PCP) knowledge and skills related to caring for cancer survivors RESULTS: Of the 251 participants in the RCT, 230 (91.6 %) responded to the 12-month phone survey and were included in this analysis; most (n = 183, 79.6 %) had breast cancer. The majority (84.8 %) considered their cancer specialist (e.g., medical, radiation, surgical or gynecological oncologist) to be their main provider for cancer follow-up and most (69.4 %) had discussed follow-up care with that provider. Approximately half of patients were uncertain how well their PCP communicated with the oncologist and how knowledgeable s/he was in caring for cancer survivors.
CONCLUSIONS:
One year after diagnosis, cancer survivors continue to view cancer specialists as their main providers and are uncertain about their PCP's skills and knowledge in managing their care. Our findings present an opportunity to help patients understand what their PCPs can and cannot provide in the way of cancer follow-up care.
IMPLICATIONS FOR CANCER SURVIVORS:
Additional research on care coordination and delivery is necessary to help cancer survivors manage their care between primary care and specialty providers.

[Jackie07]

Another related issue (New Zealand's solution):

N Z Med J. 2013 Aug 30;126(1381):75-86.
Cancer care coordinators: what are they and what will they cost?
Collinson L, Foster RH, Stapleton M, Blakely T.
Author information
Abstract
Health care resources are scarce, and future funding increases are less likely than in the past; reorientation of health services to more efficient and effective delivery is as timely as ever. In this light, we consider the recent funding decision by the Government to provide $16 million over the next 4 years for cancer coordination nurses. While the intricacies of the role are still being defined, it is likely that cancer care coordinators could benefit patients in terms of access to and timeliness of care, and patient satisfaction. Our research into the role shows that many coordinating activities for cancer patients are already being done, but often in an ad hoc manner by a number of different personnel. Thus, we estimate that the likely 'true' incremental cost of cancer care coordinators is in fact relatively low when considered in opportunity cost terms because the cancer care coordinator will be able to free up time for other staff enabling them to provide care elsewhere in the health system and reduce tasks being unnecessarily repeated. The funding of cancer care coordinators is a great opportunity to improve the timeliness of care and improve the experience of patients through their cancer journey, but the success of these roles depends on the leadership provided, peer support, continual appraisal and the resources available.