There are more than 15.5 million cancer survivors in the United States -
most of whom are five years or more beyond active treatment. Follow-up care of cancer survivors has been in focus over the past decade.
A new study by
Rutgers University and Harvard Medical School investigators examines
current literature on this subject and finds despite a number of
proposed care models, there is limited information on the role that
primary care providers play in the care of cancer survivors.
‘The review of primary care provider models in care of cancer survivors suggests opportunity for enhancement to meet all follow-up care needs.’
Cancer Institute research member Shawna V. Hudson, who is also an associate professor and research division chief in the
Department of Family Medicine and Community Health at Rutgers Robert
Wood Johnson Medical School, is the senior author of the work to be
published in the January 2017 issue of The Lancet Oncology
as part of a series of five papers on 'Cancer
Survivorship in the USA.' She shares more about the findings, which the
research team calls an "opportunity for future changes in education,
clinical practice, research and policy."
Q: Why is this topic important to explore?
half of the cancer survivors are also over the age of 70 years old and
have additional health challenges associated with aging. Eventually
most cancer survivors who are successfully treated will need to receive
additional follow-up care outside of the cancer setting for late and
long-term effects of cancer and its treatments. Therefore, ensuring
that the pathways from cancer care and active treatment to follow-up and
primary care are adequate is an important part of rehabilitation.
Ideally primary care physicians should remain a part of a patient's
clinical care throughout their cancer experience for management of other
chronic conditions and other types of health maintenance; however, we
know this is not often the case. Q: How was this study structured and what did you learn?
We examined more than a dozen journal articles that featured conceptual
models, original research or empirical examples that described models
with an integrative role for primary care. We found a number of gaps in
the literature, the most glaring being that despite a number of proposed
care models, there remains limited empirical evidence regarding
clinical outcomes. Models emphasize the use of communication tools
(i.e. survivorship care plans) and processes to assign care based on
risk factors; however, there was little evidence on how effective these
models are and scant description of the role primary care providers
might assume. Q: What is the implication of these findings and potential applications?
It is positive to know that so many survivorship care models involving
primary care providers exist, but further evaluation and development of
these models are necessary in order to meet all follow-up care needs
for cancer survivors. This provides an opportunity to implement changes
in a number of areas. For instance, a number of survivors will receive
their care in community based settings; therefore, it is important for
medical residents and practicing clinicians to be educated about cancer
survivor care needs.
Survivorship clinical practice guidelines have
traditionally focused on oncology settings, such as cancer centers or
hospital oncology units. It has only been very recently that guidelines
that focus on primary care settings have been released. As most cancer
survivors (particularly longer-term survivors) will eventually
transition from cancer settings, strategies to inform long term care are
Further, research is needed to evaluate if these efforts such
as guidelines are effective and transforming practice for survivors in
community based settings. Future research on this subject should focus
on survivorship care across diverse settings and explore care aspects
other than treatment late-effects, such as prevention, screening, and
the impact of comorbidity on rehabilitation and quality of life.