Need for education for primary care physicians on rarely seen cancers

Many primary care physicians may lack the necessary knowledge when it comes to recognizing the signs, symptoms and making proper diagnoses in cases of blood cancers such as leukemia and lymphoma, a recent survey indicates.

But co-author Richard Wender, M.D., professor and chair of Family and Community Medicine at Jefferson Medical College of Thomas Jefferson University and Jefferson's Kimmel Cancer Center in Philadelphia, says that such results are hardly surprising.

“The findings reflect the challenges that primary care doctors face,” Dr. Wender says. “Primary care physicians see a lot of patients with a variety of symptoms, often which are rarely life threatening. In the case of leukemia, the symptoms – anemia, lethargy, low-grade fever – can be over a spectrum of severity and often non-specific.”

While the results may serve as a wake-up call for more education and training, he notes, they should also point out the need for primary care physicians to be aware of a growing trend: cancer patients increasingly becoming long-term survivors who are at risk to develop second cancers years or decades later resulting from earlier cancer therapies as adults and in some cases, in childhood. The team reports its results December 10, 2007 at the annual meeting of the American Society of Hematology in Atlanta.

“Our survey shows that there are a lot of education gaps – which is not surprising since these are rare diseases,” Dr. Wender says. “Yet many of these patients live a long time, and the primary care doctors have responsibility to help coordinate care. Leukemia survivors, and in particular lymphoma survivors, almost always return to the primary care doctor for their care eventually. It probably means we need better technology and access to information. There could be some opportunities to make some diagnoses earlier.” No one knows, however, if earlier referrals would make a difference in patient survival for such diseases, he adds.

The survey was conducted by the Hematologic Oncology Primary Intervention Networking Group and for the Institute for Continuing Healthcare Education, part of a federal Centers for Disease Control and Prevention-supported initiative. The group's goal is to help patients with blood cancers live beyond the five-year mark (often considered to be a cure) by educating primary care doctors on disease signs and symptoms and encouraging appropriate referrals to specialists. The group made presentations at primary care physician meetings, distributed educational material and conducted a survey.

In all, 357 individuals responded to the survey, either online or from educational booths at meetings. In one example, when asked how to monitor a 54-year-old Hodgkin's disease survivor for five years, only 44 percent gave the correct answer. Respondents showed a lack of knowledge regarding appropriate studies to order for patient presenting with specific lab tests and symptoms consistent with leukemia.

“This is a new area of study,” Dr. Wender notes. “Primary care doctors have some shared responsibility in both cancer diagnosis and in the long-term followup.”