Hopeful
04-28-2009, 02:06 PM
J Clin Oncol. 2009 Mar 23;[Epub ahead of print], WY Cheung, BA Neville, DB Cameron, EF Cook, CC Earle
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As a result of ever-improving diagnostic procedures and cancer therapies, the number of cancer survivors in the United States has grown to 8 million. Among these survivors, care is often focused on ongoing surveillance for the primary cancer, resulting in a shift away from other important aspects of preventative and general health care (such as secondary malignancies, heart disease, and diabetes). Thus, concerns exist regarding the quality of general and preventative health care received by cancer survivors.
One reason for this concern is that the roles and responsibilities of primary care providers (PCPs) and oncologists are poorly defined in terms of medical management of survivors. Comparatively, PCPs tend to offer fewer screening tests for cancer, whereas oncologists provide less non−cancer-related care. There is an unmet need for clarification regarding the relative roles of PCPs and oncologists during the transition from active cancer treatment to survivorship management. The effect of patients’ expectations regarding survivorship planning also requires exploration.
Investigators from the Harvard School of Public Health (Cambridge, Massachusetts), Dana-Farber Cancer Institute (Boston, Massachusetts), and the Institute of Clinical Evaluative Sciences (Toronto) conducted a study to compare expectations regarding survivorship care among PCPs, oncologists, and patients. The results demonstrated a lack of agreement among these constituents with respect to their roles in ongoing survivor care.
Self-administered surveys were sent to patients who underwent cancer-related care at the Dana-Farber/Brigham and Women’s Cancer Center. The survivor surveys included questions related to expectations regarding 4 categories: follow-up for cancer recurrence, screening for other cancers, general preventive health care, and treatment of other medical problems. Corresponding surveys were sent to the survivors’ designated PCPs and oncologists.
Overall, 535 of 992 patients (54%) responded. Of the responders, 104 were excluded because of ongoing cancer treatment. The rate of physician response was 62% (378 of 607 physicians), including 255 PCPs (67%) and 123 oncologists (33%). The median patient age was 57 years (range, 16 to 91 years); 73% were female, 50% were breast cancer survivors, 74% were married, 83% were educated beyond high school, 94% were white, and 93% perceived themselves to be in good to excellent health. Survey participation yielded 409 matched patient-oncologist pairs, 233 patient-PCP pairs, and 232 PCP-oncologist pairs.
Overall, the discordance between patients and oncologists was higher than between patients and PCPs. With regard to the 4 survey categories, concordance rates between patients and oncologists were 91%, 29%, 45%, and 59% for expectations relating to follow-up for cancer recurrence, screening for other cancers, general preventive health care, and treatment of other medical problems, respectively. Thus, concordance between expectations of patients and oncologists was highest for cancer recurrence follow-up and lowest for screening for other cancers. Concordance rates between patients and PCPs were 35%, 81%, 91%, and 92% for the 4 survey categories, respectively. Thus, concordance between expectations of patients and PCPs, in contrast to that with oncologists, was high for general preventative health care and treatment of other medical problems but low for follow-up for cancer recurrence.
In the comparison between expectations of PCPs and oncologists, concordance was relatively high (81%) for the category of treatment of general medical problems. However, in the other categories, agreement was low. For cancer screening and preventative health care, the concordance rates were 44% and 51%, respectively. For primary cancer surveillance, the concordance rate was extremely low (3%). In addition, both PCPs and oncologists expected to be primarily responsible in the cancer survivorship care categories, resulting in a marked overlap in expectations. Multivariate analysis of potentially causal factors for the high discordant rates failed to identify significant characteristics. Nonsignificant trends for discordant patient-physician expectations were observed when patients were older, poorer, nonwhite, and less educated.
The results of the study demonstrated that expectations regarding survivorship care between patients and physicians and between PCPs and oncologists are highly variable. The discordance was particularly high between patients and their oncologists. The underlying causes for the discrepancies were unclear. Next steps should include analysis of the mechanisms of misperceptions among patients and physicians as well as identification of a means to more clearly define the roles for each health care professional for each category of survivor care. An opportunity obviously also exists for increased patient education about health care professionals’ roles and for patient empowerment.
Hopeful
<!--startindex-->
As a result of ever-improving diagnostic procedures and cancer therapies, the number of cancer survivors in the United States has grown to 8 million. Among these survivors, care is often focused on ongoing surveillance for the primary cancer, resulting in a shift away from other important aspects of preventative and general health care (such as secondary malignancies, heart disease, and diabetes). Thus, concerns exist regarding the quality of general and preventative health care received by cancer survivors.
One reason for this concern is that the roles and responsibilities of primary care providers (PCPs) and oncologists are poorly defined in terms of medical management of survivors. Comparatively, PCPs tend to offer fewer screening tests for cancer, whereas oncologists provide less non−cancer-related care. There is an unmet need for clarification regarding the relative roles of PCPs and oncologists during the transition from active cancer treatment to survivorship management. The effect of patients’ expectations regarding survivorship planning also requires exploration.
Investigators from the Harvard School of Public Health (Cambridge, Massachusetts), Dana-Farber Cancer Institute (Boston, Massachusetts), and the Institute of Clinical Evaluative Sciences (Toronto) conducted a study to compare expectations regarding survivorship care among PCPs, oncologists, and patients. The results demonstrated a lack of agreement among these constituents with respect to their roles in ongoing survivor care.
Self-administered surveys were sent to patients who underwent cancer-related care at the Dana-Farber/Brigham and Women’s Cancer Center. The survivor surveys included questions related to expectations regarding 4 categories: follow-up for cancer recurrence, screening for other cancers, general preventive health care, and treatment of other medical problems. Corresponding surveys were sent to the survivors’ designated PCPs and oncologists.
Overall, 535 of 992 patients (54%) responded. Of the responders, 104 were excluded because of ongoing cancer treatment. The rate of physician response was 62% (378 of 607 physicians), including 255 PCPs (67%) and 123 oncologists (33%). The median patient age was 57 years (range, 16 to 91 years); 73% were female, 50% were breast cancer survivors, 74% were married, 83% were educated beyond high school, 94% were white, and 93% perceived themselves to be in good to excellent health. Survey participation yielded 409 matched patient-oncologist pairs, 233 patient-PCP pairs, and 232 PCP-oncologist pairs.
Overall, the discordance between patients and oncologists was higher than between patients and PCPs. With regard to the 4 survey categories, concordance rates between patients and oncologists were 91%, 29%, 45%, and 59% for expectations relating to follow-up for cancer recurrence, screening for other cancers, general preventive health care, and treatment of other medical problems, respectively. Thus, concordance between expectations of patients and oncologists was highest for cancer recurrence follow-up and lowest for screening for other cancers. Concordance rates between patients and PCPs were 35%, 81%, 91%, and 92% for the 4 survey categories, respectively. Thus, concordance between expectations of patients and PCPs, in contrast to that with oncologists, was high for general preventative health care and treatment of other medical problems but low for follow-up for cancer recurrence.
In the comparison between expectations of PCPs and oncologists, concordance was relatively high (81%) for the category of treatment of general medical problems. However, in the other categories, agreement was low. For cancer screening and preventative health care, the concordance rates were 44% and 51%, respectively. For primary cancer surveillance, the concordance rate was extremely low (3%). In addition, both PCPs and oncologists expected to be primarily responsible in the cancer survivorship care categories, resulting in a marked overlap in expectations. Multivariate analysis of potentially causal factors for the high discordant rates failed to identify significant characteristics. Nonsignificant trends for discordant patient-physician expectations were observed when patients were older, poorer, nonwhite, and less educated.
The results of the study demonstrated that expectations regarding survivorship care between patients and physicians and between PCPs and oncologists are highly variable. The discordance was particularly high between patients and their oncologists. The underlying causes for the discrepancies were unclear. Next steps should include analysis of the mechanisms of misperceptions among patients and physicians as well as identification of a means to more clearly define the roles for each health care professional for each category of survivor care. An opportunity obviously also exists for increased patient education about health care professionals’ roles and for patient empowerment.
Hopeful