Clinicians Need to Coordinate More Effectively in Cancer Survivorship Care

Katherine S. Virgo, PhD

A survey of more than 2200 physicians indicated that cancer specialists and primary care physicians (PCPs) differ markedly in their concerns about the care that cancer survivors receive, reinforcing the view that a fragmented healthcare system poses one of the major barriers to care.

PCPs worry about minimizing exposure to malpractice risks, overlooking care, and lacking the training to provide adequate care for cancer survivors. Medical oncologists are more concerned about duplication of care and knowing which physician is addressing patients’ ongoing preventive-care needs, according to a presentation at the ASCO meeting in June.

“Education and survivorship care plans may be needed to alleviate barriers due to inadequate training, malpractice-driven test and treatment ordering, and confusion regarding responsibility for providing general preventive care,” said Katherine S. Virgo, PhD, managing director of health services research at the American Cancer Society (ACS) in Atlanta, Georgia.

The findings came from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS), a project sponsored jointly by the ACS and the National Cancer Institute. Using American Medical Association membership lists, investigators mailed questionnaires to 5275 physicians, all of whom were PCPs or medical oncologists. The survey garnered responses from 2202 physicians involved in the survivorship care of patients with breast and colorectal cancer: 1072 PCPs and 1130 medical oncologists.

Respondents were asked how often they encountered specific problems related to the care of breast or colon cancer survivors who completed treatment 5 or more years in the past:

• Ordering tests or treatment as protection against malpractice
• Uncertainty about who has responsibility for patients’ preventive care
• Possible duplication of care
• Missed care
• Lack of adequate knowledge or training

With regard to ordering tests to guard against malpractice, 60% of medical oncologists said they rarely or never did compared with 59% of PCPs (P <.0001). Concern about missed care was often or always on the minds of 15.1% of PCPs compared with 11.8% of the medical oncologists (P = .0047). Responsibility for general preventive care was often, always, or sometimes on the minds of 42.3% of medical oncologists versus 33.1% of PCPs (P = .0007).

“Education and survivorship care plans may be needed to alleviate barriers due to inadequate training, malpractice-driven test and treatment ordering, and confusion regarding responsibility for providing general preventive care. ”

—Katherine S. Virgo, PhD

Multivariate regression models showed that physician specialty significantly influenced respondents’ views about 3 of the 5 issues. Specifically, medical oncologists were significantly less likely to feel they were lacking in education or training (odds ratio [OR], 0.33; 95% confidence interval [CI] , 0.22-0.49) or to order tests because of malpractice concerns (OR, 0.53; 95% CI , 0.34-0.84). On the other hand, medical oncologists were significantly more likely to report that they often or always are uncertain about who has responsibility for patients’ preventive care (OR, 1.97; 95% CI, 1.13-3.43).

Virgo KS, Lerro CC, Klabunde CN, et al. Barriers in providing breast and colorectal cancer survivorship care: perceptions of US primary care physicians and medical oncologists. J Clin Oncol. 2011;29(suppl; abstr CRA9006).