Oncologists’ Perspectives of Their Roles and Responsibilities During Multi-disciplinary Breast Cancer Follow-Up

Abstract

Background Improving the quality of follow-up provided to the 3 million U.S. breast cancer survivors is a high priority. Current guidelines do not provide guidance regarding who should participate in follow-up or what providers’ specific responsibilities should be. Given the multidisciplinary nature of breast cancer care, this results in significant variation and creates the potential for redundancy and/or gaps. Our objective was to provide insight into why different types of oncologists believe their participation in follow-up is necessary. Methods A purposeful sample of breast medical, radiation and surgical oncologists was identified (n=35) and in-depth one-on-one interviews conducted. Data were analyzed using content analysis. Results Medical oncologists were driven by a sense of Responsibility for Ongoing Therapy, perceived Strong Patient Relationship, and belief that their systemic approach to follow-up represented a Specific Skillset beneficial to patients. In contrast, surgical and radiation oncologists were selective about which patients they followed, participating when they perceived their Specific Skillset of enhanced local-regional assessments would be valuable. Additionally, they endorsed participating to Ensure Follow-up is Received or not participating to Minimize Redundancy. These individual decisions led to either a Complementary Oncologist Team or Primary Oncologist follow-up approach. Conclusions Oncologists’ feel responsible for the cancer-related components of follow-up. Differences amongst oncology specialists’ perceived responsibilities influenced decisions to provide ongoing follow-up. Based on these individual decisions, a Complementary Oncologist Team or Primary Oncologist model of care evolves organically. Guidelines that explicitly direct patients into a care model have the potential to significantly improve care quality and efficiency.

Patterns of Cancer Centre Follow-Up Care for Survivors of Breast, Colorectal, Gynecologic, and Prostate Cancer

“…That variation between oncologists is not surprising. Indeed, for some oncologists, the relationships they develop with patients during the treatment period can make it difficult to transfer responsibility for care back to pcps in the community [22][23][24] . Medical oncologists have described a sense of responsibility during the follow-up period with respect to long-term toxicities and the survivor's compliance with ongoing therapies (for example, endocrine therapy) 24 ; other oncologists have questioned the ability of pcps to provide cancer-related care for survivors 25,26 .…”

“…Indeed, for some oncologists, the relationships they develop with patients during the treatment period can make it difficult to transfer responsibility for care back to pcps in the community [22][23][24] . Medical oncologists have described a sense of responsibility during the follow-up period with respect to long-term toxicities and the survivor's compliance with ongoing therapies (for example, endocrine therapy) 24 ; other oncologists have questioned the ability of pcps to provide cancer-related care for survivors 25,26 . On the other hand, survivors are often confused over who is primarily responsible for cancer follow-up care [27][28][29] and uncertain about whether community-based providers have the expertise required to manage cancer follow-up 22,30 , both of which can contribute to concerns about discharge after treatment.…”

Breast cancer survivor’s perspectives on the role different providers play in follow-up care

“…19 Oncologists were asked to identify patients within their follow-up practice that they thought “would have a perspective on breast cancer follow-up that would be important for us to hear”. Two recruitment methods were used based on preferences of the local site: 1) interested patients were provided contact information for the research team and asked to call, or 2) oncologists shared interested patient contact information with the research team, who then contacted them.…”

“…12–14,16 Some of this variation reflects oncologists tailoring of follow-up recommendations based on patients’ risk of recurrence or treatment side effects. 18,19 Oncologists also have differing perceptions of their individual roles and responsibilities for breast cancer follow-up. Further, some oncologists cite breast cancer survivor’s preference as one reason they continue to participate in ongoing follow-up.…”

“…Further, some oncologists cite breast cancer survivor’s preference as one reason they continue to participate in ongoing follow-up. 19 In current clinical practice, each oncology provider independently makes the decision whether to actively participate in follow-up or defer care to others. The lack of clear guidance regarding who should provide follow-up is one source of variation, which creates potential for both redundancy (overuse) and gaps (underuse) in follow-up care.…”