Differences between primary care physicians' and oncologists' knowledge, attitudes and practices regarding the care of cancer survivors

Abstract

Background: The growing number of cancer survivors combined with a looming shortage of oncology specialists will require greater coordination of post-treatment care responsibilities between oncologists and primary care physicians (PCPs). However, data are limited regarding these physicians' views of cancer survivors' care.

Objective: To compare PCPs and oncologists with regard to their knowledge, attitudes, and practices for follow-up care of breast and colon cancer survivors.

Design and subjects: Mailed questionnaires were completed by a nationally representative sample of 1,072 PCPs and 1,130 medical oncologists in 2009 (cooperation rate = 65%). Sampling and non-response weights were used to calculate estimates to reflect practicing US PCPs and oncologists.

Main measures: PCPs and oncologists reported their 1) preferred model for delivering cancer survivors' care; 2) assessment of PCPs' ability to perform follow-up care tasks; 3) confidence in their knowledge; and 4) cancer surveillance practices.

Key results: Compared with PCPs, oncologists were less likely to believe PCPs had the skills to conduct appropriate testing for breast cancer recurrence (59% vs. 23%, P < 0.001) or to care for late effects of breast cancer (75% vs. 38%, P < 0.001). Only 40% of PCPs were very confident of their own knowledge of testing for recurrence. PCPs were more likely than oncologists to endorse routine use of non-recommended blood and imaging tests for detecting cancer recurrence, with both groups departing substantially from guideline recommendations.

Conclusion: There are significant differences in PCPs' and oncologists' knowledge, attitudes, and practices with respect to care of cancer survivors. Improving cancer survivors' care may require more effective communication between these two groups to increase PCPs' confidence in their knowledge, and must also address oncologists' attitudes regarding PCPs' ability to care for cancer survivors.

Figure 1

Sample flow diagram for the 2009 Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS).

Figure 2

Preferred model For cancer follow-up care: Dark bars= primary care physicians; Lighter bars=Oncologists. Y-Axis shows percent (weighted) of physicians responding with their top ranked preference among the following 5 options for models for the delivery of cancer survivors’ care: 1. PCPs and oncologists share responsibility; 2. Medical Oncologists have primary responsibility; 3. PCPs have primary responsibility; 4. Specialized clinics led by physicians who focus on survivor care; 5. Specialized clinics led by Oncology Nurses, Certified Registered Nurse Practitioners, or Physician Assistants. Five percent (5%) of PCPs and 3% of oncologists endorsed more than 1 option as their top preferred model, and are not included in the figure. Chi-sq. test of difference in preference by physician group was P < 0.001.

Figure 3

Confidence in knowledge about breast cancer follow-up care components. Dark bars=primary care physicians; Lighter bars=Oncologists. Y-Axis shows percent (weighted) of physicians responding that they were “very confident” versus “not at all confident” or “somewhat confident” to the following question: How confident do you feel about your knowledge of the following aspects of cancer-related follow-up care for breast cancer survivors? a. Appropriate surveillance testing to detect recurrent cancer; b. long-term and late physical adverse effects of cancer and cancer treatment; c. the potential adverse psychosocial outcomes of cancer or its treatment. Fewer than 2% responded “Don’t Know” and are excluded from the figure. Chi-sq. tests of differences by physician group for each of the 3 components were all P < 0.001.