CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.
The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.
The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.
"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."
A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.
The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.
"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.
Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).
As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).
"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.
Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).
For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).
"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.
Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.
Dr. Virgo reported no relevant financial conflicts.