Primary Care Providers Uneasy on Cancer Survivorship Care

[Hopeful]

Elsevier Global Medical News. 2010 Feb 26, C Helwick

NEW ORLEANS (EGMN) - Primary care providers often feel unequipped to deal with issues of cancer survivorship, according to a survey of 103 physicians, nurse practitioners, and physician assistants at the Henry Ford Health System in Detroit.

More than half (61%) were uncertain about their role in follow-up care (surveillance) for the most common types of cancer, Teresa Lynch, Ph.D., reported at the annual conference of the American Psychosocial Oncology Society. These included lung, breast, prostate, colorectal, bladder, melanoma, non-Hodgkin's lymphoma, kidney/renal cell, leukemia, and endometrial malignancies.

Nearly half (46%) were uncertain of the patterns of morbidity associated with cancer treatments, she added, and 31% were uncertain as to what medical interventions are recommended for preventing or remediating morbidities associated with common cancers.

"Surveys of patients and professionals indicate that posttreatment cancer care is at best fragmented and at worse nonexistent," said Dr. Lynch, a psychologist at the Josephine Cancer Center at Henry Ford. "PCPs do want to care for cancer patients. They believe it is part of their role, but they are currently very unclear as to what their exact responsibilities are - who does what between the PCP and the oncologist?"

Dr. Lynch and colleagues are initiating a survivorship program to address the posttreatment needs of approximately 4,000 new cancer patients a year at their center. The program will incorporate care plans into the electronic medical record (EMR), and provide education to fill the gaps in knowledge that they are identifying in surveys of PCPs.

This study involved 103 PCPs who provide services within the large, diverse health care system, and who had access to EMRs. The online survey questioned their beliefs and attitudes about providing survivorship care - specifically, their knowledge of survivorship care and surveillance; the availability of information related to patents' survivorship care; the clarity of roles and responsibilities in providing survivorship care; and the availability and efficacy of psychosocial resources.

Approximately half of the respondents were house officers, 30% were senior staff, and the rest were nurse practitioners or physician assistants. In all, 42% were 20-30 years of age, 17% were 31-40, 14% were 41-50, and 27% were 51 years or older.

In all categories, older providers felt less familiar with the issues, and house officers felt most confident, Dr. Lynch reported. Significantly, older providers also said that they were not completely comfortable in caring for cancer patients in their practices.

"Providers definitely thought it was important for them to understand cancer follow-up plans, but over 40% thought they did not receive timely information about changes in their patients' cancer status, medications or treatments," she said. "Almost 30% of PCPs had difficulty determining patients' follow-up plans in the EMR."

An "alarming" number of providers (more than half) said they "rely" on patients to inform them of their follow-up plans, she continued. Yet more than 80% of providers believed their patients are confused about follow-up.
"Based on these survey results, we believe that providers need a reliable source to guide their care of cancer patients, and patients need to be better informed about recommendations for follow-up care," she concluded.

Regarding psychosocial services, only about half of the respondents indicated that they were comfortable asking their patients about emotional, family, and spiritual distress. Those who were more comfortable were also more likely to know when and where to refer patients for psychosocial services, and felt that their patients' needs were met by these referrals. Only 35% felt that the psychosocial needs of their patients were being met.

Dr. Lynch and colleagues will use these answers to address gaps in knowledge and guide the development of their survivorship plan. "We believe that improving the PCPs' ability to coordinate care for cancer survivors will lead to increased patient satisfaction and prevent the under- and over-utilization of health care services," she said. "As it is now, physicians are duplicating services or not performing the right ones. When patients and physicians use services appropriately, health care costs are ultimately reduced."

Dr. Lynch disclosed no conflicts of interest.

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