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Cancer Survivors Are Skipping the Primary Care Doctor
Fewer than half of cancer survivors visit a primary care clinician during their fifth through seventh years following their diagnosis, according to a new study published in JCO Oncology Practice .
'Primary care providers' engagement with cancer survivors is viewed as really important, not just for detection of a recurrence or a new cancer but to manage chronic diseases that are not cancer-related, like diabetes, and diseases caused or complicated by cancer treatment, like cardiovascular disease,' said Sarah Birken, PhD, associate professor at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and an author of the study.
Previous research found cancer survivors have improved health outcomes for comorbid conditions when primary care clinicians are involved in their care.
The study included 516 survivors of breast, colorectal, or uterine cancer treated at the Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem. Birken and her colleagues linked cancer registry data to outpatient visits with a physician, nurse practitioner, or physician assistant working in family or internal medicine.
Fewer than half (43%) of patients had one of these visits in years 5, 6, and 7 following their initial diagnosis, defined as 'sustained' engagement.
Those with sustained engagement were 4.6 years older, on average, than those who did not have these visits. The odds of engaging with a primary care clinician rose by 36% for every decade older a person was at the time of cancer diagnosis.
Previous Research
Birken said the findings reinforce those of a 2023 study which found 40% of patients diagnosed with breast cancer reported communicating with primary care clinicians less over time.
Kevin Oeffinger, MD, professor at the Duke University School of Medicine and founding director of the Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina, said he was surprised by the findings because of the research showing the importance of primary care in the follow-up of cancer survivors.
'The study highlights the need for better collaboration between primary care providers and oncologists,' Oeffinger, author of an editorial accompanying the journal article, told Medscape Medical News .
A 2005 report by the Institute of Medicine recommended clinicians who coordinate oncology treatment provide patients a survivorship care plan.
Despite 20 years of work since the report, 'there does not appear to be an overall improvement in the quality transition of survivors from the oncology team to the primary care team or evidence that shared care is becoming the norm,' Oeffinger and his coauthors wrote in the editorial.
Going Forward
Birken and her colleagues said their findings should be used to promote engagement of primary care clinicians in long-term care of these patients.
However, she cited some challenges to achieving this goal. Oncologists must have connections with a large number of primary care clinicians for referrals. Primary care clinicians are also often disconnected from patient care during cancer treatments.
Birken said one of the notable findings in the study younger patients were less likely to have visits with primary care clinicians.
'We know that people are being diagnosed with cancer at younger and younger ages, and so an implication of this study could be that we're setting ourselves up for things to worsen with respect to primary care engagement,' Birken said. 'Younger people tend to be less engaged in healthcare; after so many oncology visits following a cancer diagnosis, primary care my feel like yet another unwanted provider visit.'
The study was supported by a grant from the National Cancer Institute's Cancer Center. Oeffinger reported being a consultant for and having stock and other ownership interests in Maia Oncology and receiving research funding from GRAIL.
