A mixed method study of medical oncologists’ perceived barriers and motivators to addressing long-term effects in breast cancer survivors

Abstract

Purpose The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors. Methods This study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data. Results Key barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: “Competing priorities during brief appointments;” “Discussing long-term effects—Who? What? When?;” and “Beyond my expertise and comfort level.” Two motivator categories emerged: “I owe it to them;” and “Giving people a life worth living.” Conclusion Oncologists’ key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients' quality of life. Future efforts should leverage oncologists' professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer.

Cancer survivor late-effects, chronic health problems after cancer treatment: what’s the evidence from population and registry data and where are the gaps?

“…Secondary prevention and lifestyle interventions reduce risks of both recurrence and CVD, but the challenge is in identifying those at higher risk of late effects and implementing early prehabilitation and lifestyle interventions through multi-disciplinary care [32,33]. Surveys highlight that adherence to guidelines for cancer survivors is suboptimal in both secondary and primary care [34,35]. A recent survey of medical oncologists in the United States found that only 46% provided survivorship care plans for women with breast cancer, 34% assessed for emotional distress and only 34% screened for additional cancers.…”