Here’s How Primary Cancer Physicians View Their Care Delivery Roles for Survivors

A new study examined the view of primary care physicians regarding their role in care for cancer survivors.

By the year 2040, an estimated 26.1 million cancer survivors will be living in the United States. This includes a significant proportion of childhood cancer survivors who will be living with disease-related comorbidities into adulthood. As the population of survivors increases, an oncology services shortage will also persist.

Caring for cancer survivors is not a clear-cut path because the definition of a cancer survivor remains debated: “There is no clear consensus on the definitions of survivors and survi-vorship. The National Cancer Institute defines cancer survivors as persons from the time of cancer diagnosis until the end of life, while other organizations, such as the American Society of Clinical Oncology, view cancer survivorship care as beginning in ‘the period following acute diagnosis and treatment,’” explain the study authors.

To garner a better understanding of the viewpoint of primary care physicians, the researchers interviewed 38 clinicians in 14 primary care practices with “national reputations as workforce innovators,” they described. The conversations included the clinicians describing how they view their role in cancer survivorship, as well as how and where they decide to refer their patients and their understanding of new primary care-friendly survivorship care guidelines. Interviews ranged from one to three hours and were recorded so verbatim transcripts could be assessed. Respondents included medical doctors/doctors of osteopathic medicine and nurse practitioners/physician assistants.

Most respondents were physicians (76%), female (60%), and aged between 20 and 70 years. More than half of practices (57%) were in suburban areas. Nine practices (64%) had National Committee of Quality Assurance  Level 3 patient-centered medical home status, while three were Direct Care practices and one each were a Veterans Administration practice and a nurse-led Federally Qualified Health Center.

Primary Care Physicians View Roles, Definitions Differently

The interviews unveiled “divergent views on the role of primary care in care of cancer survivors,” the study authors said.

Five clinicians did not believe that survivorship care fell under the purview of primary care, saying that any care that follows acute treatment is the responsibility of the oncologist. One physician said, “[M]y presumption is that if [patients with a history of cancer] have needs, they’re going to be hooked in with an oncologist. So, there’s a territory or turf issue here.” A nurse practitioner said the topic “doesn’t come to our attention that much” and echoed that it “gets taken care of” by oncology.

Among the majority of clinicians who agreed that survivorship falls into the realm of primary care, there was less agreement on what that actually means. One physician pointed to an education gap: “[Cancer treatment] kind of happens like in a black box… I feel a little intimidated by it, to be honest with you… I don’t feel like I know enough about the long-term side effects of the chemo toxic agents.” Another gave a similar sentiment and said many primary care physicians have “low confidence” in the area.

One clinician said that while primary care physicians should be the ones taking care of survivors, “historically, oncologists are very possessive of their patients. Once they’re an oncology patient, they’re an oncology patient.”

The definition of a survivor also varied, the authors noted. Some primary care physicians grouped cancer survivors into their own population, while others saw no difference between them and all chronic disease patients.

“In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge,” the researchers added.

The study was published in Annals of Family Medicine.