Rural Primary Care Offices and Cancer Survivorship Care: Part of the Care Trajectory for Cancer Survivors

Abstract

Background:A cancer diagnosis is a monumental event in a patient’s life and with the number of cancer survivors increasing; most of these patients will be taken care of by a primary care provider at some point after their cancer therapy. The purpose of this study is to identify primary care physician’s needs to care for a patient who has had cancer.Methods:A cross-sectional survey of the physician members of the Iowa Research Network was conducted. The survey was designed to measure physician confidence in cancer survivor’s care, office strategies regarding cancer survivorship care, and resources available for patients with cancer. Two hundred seventy-four Iowa Research Network members were invited to participate in this survey.Results:Eighty-two physicians (30%) completed the questionnaire with 96% reporting that they are aware of their patient’s cancer survivorship status. Seventy-one physicians reported they were aware of cancer survivorship status by an oncologist sending a note to the office, 68 being diagnosed in their office, 61 by the patient keeping the office apprised, and 15 receiving a survivorship care plan. Physicians reported the top changes in a cancer survivor’s physical health as fatigue (81%) and pain (59%). Sixty-two physicians reported not feeling confident for managing chemobrain, cardiotoxicity (71%), and skin changes (35%). Male physicians were significantly more confident managing patients’ skin changes (P = .049) and musculoskeletal disturbances than female physicians (P = .027), while female physicians were significantly more confident managing early-onset menopause than male physicians (P = .027).Conclusion:Most respondents are aware of their patients who are cancer survivors and are mostly confident in the care they provide for them related to long-term effects and side effects of cancer therapies with limited receipt of cancer survivorship care plans.

Primary care physicians’ knowledge and confidence in providing cancer survivorship care: a systematic review

“…Even though PCPs generally reported good or adequate skills in detecting recurrences [21-23, 34, 49] and providing follow-up care [21,22,35,49], their confidence to do so was rated much lower than their knowledge [21,29,31,32,34,49]. While our study did not address these factors, others have found lower confidence levels related to fewer (years of) experience [26, 31-34, 38, 39] and female sex [26,30,33,39]. Confidence may also be related to the cancer survivor population of interest [29,45,51] as PCPs may only see a limited number of patients with particular types of cancer.…”

“…Knowledge and confidence in management of physical effects was described in 13 studies. About half of these studies (n = 7) did not specify the physical effect under evaluation [21,22,24,32,39,49,51], while others (n = 6) focused on specific symptoms, such as fatigue and treatment-related osteoporosis [26,28,[36][37][38]40]. Only four studies examined knowledge of PCPs regarding physical effects [24,28,36,40].…”

“…Overall, between 10-37% of PCPs reported (high) confidence in providing care for physical effects (n = 8) [21,22,32,37,39,40,49,51]. Confidence was rated differently for specific physical effects [26,38], for example 79% of PCPs felt confident in managing fatigue, whereas only 16% felt confident in managing chemobrain [26].…”

“…None of the included studies measured knowledge of psychosocial effects. Seven studies examined PCPs' confidence in the management of psychosocial effects [21,26,32,37,40,49]. In general, a greater proportion of PCPs were confident in managing psychosocial effects than physical effects.…”

“…*Because some of the papers were based on the same dataset, both the total number of papers, and the number of unique studies is provided [21,32,37,40,49]. In the study by Berry-Stoelzle et al, in which a 4-point Likert scale was reduced into "confident" vs. "not confident", almost 100% of PCPs were confident in managing depression, anxiety and sleep disturbances [26].…”