Primary Care Physician Perceptions of Adult Survivors of Childhood Cancer

Abstract

Increasing cure rates for childhood cancers have resulted in a population of adult childhood cancer survivors (CCS) that are at risk for late effects of cancer-directed therapy. Our objective was to identify facilitators and barriers to primary care physicians (PCPs) providing late effects screening and evaluate information tools PCPs perceive as useful. We analyzed surveys from 351 practicing internal medicine and family practice physicians nationwide. A minority of PCPs perceived that their medical training was adequate to recognize late effects of chemotherapy (27.6%), cancer surgery (36.6%), and radiation therapy (38.1%). Most PCPs (93%) had never used Children’s Oncology Group guidelines, but 86% would follow their recommendations. Most (84–86%) PCPs stated that they had never received a cancer treatment summary or survivorship care plan but (>90%) thought these documents would be useful. PCPs have a low level of awareness and receive inadequate training to recognize late effects. Overall, PCPs infrequently utilize guidelines, cancer treatment summaries, and survivorship care plans, although they perceive such tools as useful. We have identified gaps to address when providing care for CCS in routine general medical practice.

Survivorship care plan preferences of cancer survivors and health care providers: a systematic review and quality appraisal of the evidence

“…This is particularly true regarding the provision of the cancer staging characteristics and treatment overview when presented in a concise and abridged manner [20,40,43,46,50]. Of the studies that asked, PCPs did not have a strong preference for electronic copies, particularly if they already had access to the electronic record [43][44][45].…”

“…Several studies suggested that PCPs overwhelmingly believed that TS/SCP were useful as a communication tool between the oncology and primary care teams [20,22,34,39,43,45,46,50,52]. This is particularly true regarding the provision of the cancer staging characteristics and treatment overview when presented in a concise and abridged manner [20,40,43,46,50].…”

“…However, one study noted that some PCPs preferred a paper record to place in the patient's chart [45]. Some studies suggested that the pools of PCP respondents were uncomfortable with the provision of surveillance and survivorship care, citing knowledge deficits in oncology care [34,39,45,46]. These studies directly contrast Hewitt et al [22] and Smith et al [50], in which the majority of PCPs stated that they were comfortable with providing survivors survivorship care, and cited doing so as an Bimportant role^in the provision of posttreatment care.…”

Impact of shared care program in follow‐up of childhood cancer survivors: An intervention study

“…On the other hand, GPs showed they could be identified by the survivors as reliable doctors in the field. The closeness of the collaboration between GPs and cancer centers is essential . This includes a well‐organized transition (providing GPs with all the necessary information for adequate care) and an SCP (detailed problem‐oriented strategy).…”

Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

“…Recent surveys of general internists suggest that many remain uncomfortable providing risk-based survivor-focused medical care to long-term adult survivors of childhood cancer. 28,29 Outreach and education for these providers are particularly important given the well-described association between receiving a physician recommendation for riskbased screening and completion of recommended mammogram, [30][31][32] echocardiogram, and bone density screening. 30,33 In the general population, cancer screening rates vary according to population-level factors, with lower breast cancer screening rates in communities with lower mammogram capacity, 15 and lower breast and colon cancer screening rates in communities with higher area-level poverty rates.…”