The Role of Family Physicians in Cancer Care: Perspectives of Primary and Specialty Care Providers

Easley, Julie; Miedema, Baukje; O’Brien, Mary Ann; Carroll, June C.; Manca, Donna; Webster, Fiona; Grunfeld, Eva

doi:10.3747/co.24.3447

Cited by 65 publications

(54 citation statements)

References 13 publications

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“…7 Another likely explanation for this disparity in survival could be different patterns of treatment for patients with and without PCPs, because PCPs have shown to play a critical role in managing routine cancer care. 6,8,9 This is evident in our study in which we found that within the insured cohort, patients without PCPs had significantly lower rates of treatment with TMZ and XRT, and lower enrollment in clinical trials, which is reflected in their overall survival (Table 5). …”

Section: Discussionmentioning

confidence: 65%

“…6 Thus, it is not surprising that patients with a designated PCP have better survival outcomes when compared to their counterparts. When looking at possible variables that could explain the disparity in survival within the insured cohort, we found that patients who did not have PCPs had a larger tumor burden at diagnosis when compared to those with PCP coverage, supporting the notion of the role of PCPs in early diagnosis of disease.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in health care determine prognosis in newly diagnosed glioblastoma

Chandra¹,

Rick²,

Ore³

et al. 2018

Neurosurgical Focus

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OBJECTIVEGlioblastoma (GBM) is an aggressive brain malignancy with a short overall patient survival, yet there remains significant heterogeneity in outcomes. Although access to health care has previously been linked to impact on prognosis in several malignancies, this question remains incompletely answered in GBM.METHODSThis study was a retrospective analysis of 354 newly diagnosed patients with GBM who underwent first resection at the authors’ institution (2007–2015).RESULTSOf the 354 patients (median age 61 years, and 37.6% were females), 32 (9.0%) had no insurance, whereas 322 (91.0%) had insurance, of whom 131 (40.7%) had Medicare, 45 (14%) had Medicaid, and 146 (45.3%) had private insurance. On average, insured patients survived almost 2-fold longer (p < 0.0001) than those who were uninsured, whereas differences between specific insurance types did not influence survival. The adjusted hazard ratio (HR) for death was higher in uninsured patients (HR 2.27 [95% CI 1.49–3.33], p = 0.0003). Age, mean household income, tumor size at diagnosis, and extent of resection did not differ between insured and uninsured patients, but there was a disparity in primary care physician (PCP) status—none of the uninsured patients had PCPs, whereas 72% of insured patients had PCPs. Postoperative adjuvant treatment rates with temozolomide (TMZ) and radiation therapy (XRT) were significantly less in uninsured (TMZ in 56.3%, XRT in 56.3%) than in insured (TMZ in 75.2%, XRT in 79.2%; p = 0.02 and p = 0.003) patients. Insured patients receiving both agents had better prognosis than uninsured patients receiving the same treatment (9.1 vs 16.34 months; p = 0.025), suggesting that the survival effect in insured patients could only partly be explained by higher treatment rates. Moreover, having a PCP increased survival among the insured cohort (10.7 vs 16.1 months, HR 1.65 [95% CI 1.27–2.15]; p = 0.0001), which could be explained by significant differences in tumor diameter at initial diagnosis between patients with and without PCPs (4.3 vs 4.8 cm, p = 0.003), and a higher rate of clinical trial enrollment, suggesting a critical role of PCPs for a timelier diagnosis of GBM and proactive cancer care management.CONCLUSIONSAccess to health care is a strong determinant of prognosis in newly diagnosed patients with GBM. Any type of insurance coverage and having a PCP improved prognosis in this patient cohort. Higher rates of treatment with TMZ plus XRT, clinical trial enrollment, fewer comorbidities, and early diagnosis may explain survival disparities. Lack of health insurance or a PCP are major challenges within the health care system, which, if improved upon, could favorably impact the prognosis of patients with GBM.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Chandra¹,

Rick²,

Ore³

et al. 2018

Neurosurgical Focus

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“…Most patients did not see the GP during their treatment; however, those who did noted that the GPs focused on psychosocial issues rather than their treatment. A Canadian study identified challenges inhibiting the GP's involvement in the cancer pathway, including the GP's lack of up‐to‐date knowledge about cancer treatment and the experience that patients “disappear” in the cancer system . In a German study, patients described the GP as an important person in the cancer trajectory, and the majority (71%) visited their GP during cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

Surgical breast cancer patient pathway: Experiences of patients and relatives and their unmet needs

Zøylner

Lomborg

Christiansen

et al. 2019

Health Expectations

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Background and aim Breast cancer is the most common cancer disease in women worldwide. In Denmark, the law prescribes cancer patient pathways (CPPs) in general and thus also for breast cancer. Although results from patient satisfaction surveys show overall satisfaction with the pathway, a call for improvement has been voiced for some areas. The aim of this study was to explore patients’ and relatives’ experiences with the surgical breast CPP and to identify any unmet needs. Method This study was based on focus groups with patients who had surgery for breast cancer, and their relatives. The settings were two Danish surgical breast cancer clinics. Findings Overall, patients and relatives found the structure of the surgical breast CPP satisfactory. The time in the surgical department was short, and most patients found it difficult to cope with the situation. Empathy and a supportive relationship between patients, relatives and health‐care professionals were of great importance. Five key points were identified in which some of the participants had unmet needs. Suggestions for change were related to information, communication, choice of treatment, flexibility in the pathway and easy access to the clinic after surgery. Conclusion Although patients and relatives found the CPP for breast cancer satisfactory and well planned, suggestions for change were made relating to unmet needs with respect to five key points in the pathway. Implementing findings from this study in clinical practice requires co‐operation between health‐care professionals and support from the leaders of the organization.

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“…[1][2][3][4][5][6] Primary healthcare (PHC) services have an important role in post-discharge cancer care, and accurate communication between hospitalbased specialists and PHC services is imperative. 7,8 In high-income countries with universal healthcare systems, there is increasing acceptance of the role of GP in cancer care. [8][9][10][11][12][13] High quality PHC is particularly important for groups who experience disproportionate barriers to access to care; such as ethnic minorities, 14 patients who live in rural 15 and more deprived areas 14,16 and indigenous populations.…”

Section: Introductionmentioning

confidence: 99%

Are general practitioners getting the information they need from hospitals and specialists to provide quality cancer care for Indigenous Australians?

Valery

Bernardes

Witt

et al. 2020

Internal Medicine Journal

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Background Cancer care involves many different healthcare providers. Delayed or inaccurate communication between specialists and general practitioners (GP) may negatively affect care. Aim To describe the pattern and variation of communication between primary healthcare (PHC) services and hospitals and specialists in relation to the patient's cancer care. Methods A retrospective audit of clinical records of Indigenous Australians diagnosed with cancer during 2010–2016 identified through 10 PHC services in Queensland is described. Poisson regression was used to model the dichotomous outcome availability of hospital discharge summary versus not. Results A total of 138 patient records was audited; 115 of those patients visited the PHC service for cancer‐related care after cancer diagnosis; 40.0% visited the service before a discharge summary was available, and 36.5% of the patients had no discharge summary in their medical notes. While most discharge summaries noted important information about the patient's cancer, 42.4% lacked details regarding the discharge medications regimen. Conclusions Deficits in communication and information transfer between specialists and GP may adversely affect patient care. Indigenous Australians are a relatively disadvantaged group that experience poor health outcomes and relatively poor access to care. The low proportion of discharge summaries noting discharge medication regimen is of concern among Indigenous Australians with cancer who have high comorbidity burden and low health literacy. Our findings provide an insight into some of the factors associated with quality of cancer care, and may provide guidance for focus areas for further research and improvement efforts.

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The Role of Family Physicians in Cancer Care: Perspectives of Primary and Specialty Care Providers

Abstract: Background Currently, the specific role of family physicians (fps) in the care of people with cancer is not well

Cited by 65 publications

References 13 publications

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Surgical breast cancer patient pathway: Experiences of patients and relatives and their unmet needs

Are general practitioners getting the information they need from hospitals and specialists to provide quality cancer care for Indigenous Australians?

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