For more than a decade, there has been a focus on involving primary care providers in the follow-up care of cancer survivors. A new study by Rutgers University and Harvard Medical School investigators examines current literature on this subject and finds despite a number of proposed care models, there is limited information on the role that primary care providers play in the care of cancer survivors. Rutgers Cancer Institute research member Shawna V. Hudson, PhD, who is also an associate professor and research division chief in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, is the senior author of the work to be published in the January 2017 issue of The Lancet Oncology (Lancet Oncol 2017; 18: e30-38) as part of a series of five papers on 'Cancer Survivorship in the USA.' She shares more about the findings, which the research team calls an "opportunity for future changes in education, clinical practice, research and policy."
Q: Why is this topic important to explore?
A: There are more than 15.5 million cancer survivors in the United States - most of whom are five years or more beyond active treatment. More than half of these cancer survivors are also over the age of 70 years old and have additional health challenges associated with aging. Eventually most cancer survivors who are successfully treated will need to receive additional follow-up care outside of the cancer setting for late and long-term effects of cancer and its treatments. Therefore, ensuring that the pathways from cancer care and active treatment to follow-up and primary care are adequate is an important part of rehabilitation. Ideally primary care physicians should remain a part of a patient's clinical care throughout their cancer experience for management of other chronic conditions and other types of health maintenance; however, we know this is not often the case.
Q: How was this study structured and what did you learn?
A: We examined more than a dozen journal articles that featured conceptual models, original research or empirical examples that described models with an integrative role for primary care. We found a number of gaps in the literature, the most glaring being that despite a number of proposed care models, there remains limited empirical evidence regarding clinical outcomes. Models emphasize the use of communication tools (i.e. survivorship care plans) and processes to assign care based on risk factors; however, there was little evidence on how effective these models are and scant description of the role primary care providers might assume.
Q: What is the implication of these findings and potential applications?
A: It is positive to know that so many survivorship care models involving primary care providers exist, but further evaluation and development of these models are necessary in order to meet all follow-up care needs for cancer survivors. This provides an opportunity to implement changes in a number of areas. For instance, a number of survivors will receive their care in community based settings; therefore, it is important for medical residents and practicing clinicians to be educated about cancer survivor care needs. Survivorship clinical practice guidelines have traditionally focused on oncology settings, such as cancer centers or hospital oncology units. It has only been very recently that guidelines that focus on primary care settings have been released. As most cancer survivors (particularly longer-term survivors) will eventually transition from cancer settings, strategies to inform long term care are needed. Further, research is needed to evaluate if these efforts such as guidelines are effective and transforming practice for survivors in community based settings. Future research on this subject should focus on survivorship care across diverse settings and explore care aspects other than treatment late-effects, such as prevention, screening, and the impact of comorbidity on rehabilitation and quality of life.
Rutgers Cancer Institute of New Jersey