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Should Oncologists or PCPs Provide Survivorship Care

Posted 1/22/2016

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  This is an ongoing question in Cancer World: should survivors (in this case, meaning people who have completed active treatment for cancer and are hoping to stay well) be followed by their medical oncologists or by their PCPs? Part of the issue is likely related to time and finances. If oncologists continue to see all of their worried well patients, they have less available time for new cancer patients or for people who are very ill. A standard oncology visit also costs more than a standard visit with a PCP, and everyone is thinking about health care costs.

  There is also real data to suggest that, in some cases, it does not make any difference in ongoing health or survival. Many people are shocked at how little is done at follow up visits after, for example, adjuvant treatment for breast cancer. The standard oncology care then consists of a visit with the medical oncologist every 4-6 months, probably a visit with the breast surgeon every 6-12 months, perhaps a similar visit with the radiation oncologist, and an annual mammogram. At the medical oncology visit. there is a breast exam and a conversation about how you are doing, and that's it. Usually no blood tests. Certainly no x-rays or scans unless there is a symptom and a reason to be concerned. For some other cancers, e.g. ovarian cancer, there are blood markers that are often (not always) an accurate way to track cancer activity, so blood tests are always done.

  If we sit back and think about it, it is obvious that a good PCP can do a breast exam, order a mammogram, and have a conversation about health that includes the cancer-related questions. A good PCP, if there is a concern, will immediately involve the oncologist.

  There is a psychological piece to this, too. I often talk with people about whom to call if they have a worry. Some people prefer to immediately reach out toe the oncologist because, after all, cancer is the real fear, and let's just get that right on the table. Other people prefer to minimize the fear and start with the PCP--and often that is enough.

  Here is the start of a good article from MedScape about this and then a link to read more:

Who Is Caring for Cancer Survivors: Oncologists or PCPs?
Roxanne Nelson, BN, RN

Is the ideal model of care for cancer survivors one led by oncologists, one led by primary care physicians (PCPs), or a shared model?

Unfortunately for the patients, that question remains largely unresolved. There are still mixed views and uncertainty about who should assume responsibility for survivorship care, even in an integrated healthcare system, according to a study presented here at the inaugural Cancer Survivorship Symposium Advancing Care and Research.

For example, none of the PCPs surveyed preferred a model led by the PCP, and instead preferred that the oncologist take primary responsibility for follow-up care. In contrast, oncologists preferred a model of shared responsibility.

As a result, 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.

Read more:


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