Survivorship has become a very important part of cancer care as more and more of us survive a longer time. If our cancer has gone into remission we still need additional care, both physical and mental care. An unanswered question in today’s healthcare delivery system is who should be providing the care, a primary care physician (PCPs), an oncologist or perhaps a shared model?
According to a study presented at the ASCO Cancer Survivorship Symposium Advancing Care and Research in San Francisco, showed that there is no consensus between the various physician groups as to who should be responsible for survivorship care.
The surprise result of a survey of the PCPs was that they preferred a model where the PCP did not lead the care, but that an oncologist takes primary responsibility for follow-up care. In contrast, oncologists preferred a model of shared responsibility.
It is the patients who then “take it on the chin” when there doesn’t seem to be an agreement between the treating doctors. It is possible that the oncologists might be assigning more responsibility of survivorship care to the PCPs than the PCPs recognize, and patients might not be getting their recommended care, explained lead author Bijal A. Balasubramanian, MBBS, PhD, assistant professor in the division of epidemiology, human genetics, and environmental science at the University of Texas School of Public Health in Dallas.
Balasubramanian said, “What we found is that both agree that primary care physicians have the skills to care for these patients…… There is agreement there, but it’s still a new problem for the health system. But when you ask about the preferred model, the PCPs do not want a primary-care-led model.”
The other disconcerting surprise finding was that of the physicians who participated in the survey only 30% of oncologists and 23% of PCPs expressed an interest in a shared model, the model prefered by the oncologists.
Previous research using nationally (United States) representative data showed significant differences between the attitudes of PCPs and oncologists and their practices with respect to the care of cancer survivors. In one sample of PCPs and oncologists it was found that oncologists have an “unfavorable view” of giving PCPs a central role in caring for cancer survivors. PCPs also expressed mixed views about assuming increased responsibility for survivorship care. The majority of oncologists favored a model led by oncologists, but almost half of all PCPs preferred a shared-care model or one led by PCPs.
Given that there are a rapidly growing number of cancer survivors, that is estimated to be about 12 million people in the United States in 2014, this problem is one of major significance.
Survivorship care after cancer treatment is important, however it remains unclear how best to provide high quality care and who should deliver that care. These study only points out the problem, so how can we go about and guarantee consistent and high quality care for 12 million people?
Cancer Survivorship Symposium (CSS) Advancing Care and Research: Abstract 105. Presented January 15, 2016.