Adult Cancer Survivors Discuss Follow-up in Primary Care: ‘Not What I Want, But Maybe What I Need’

Dr. Hudson and colleagues conducted a qualitative study examining the perspectives of early-stage breast and prostate cancer survivors regarding follow-up care. This paper adds to the body of knowledge that is emerging regarding expectations for primary care providers (PCPs) and cancer specialists in providing follow-up care. Our own group has conducted both quantitative and qualitative research investigating the quality of non-cancer care provided to cancer survivors, including preventive care (e.g., flu shots, cholesterol screening) and comorbid condition care. Among breast cancer survivors, we have consistently found that survivors who receive care from both a primary care provider and cancer specialist are most likely to receive appropriate care.[1,2] In prostate cancer, we found that PCP visits were associated with 3/3 measures of appropriate care in the year following diagnosis and on 2/3 measures for five-year survivors, even when controlling for visits to other physician specialties.[3] In contrast, oncology specialist visits were not associated with appropriate care receipt on any of the 3 measures during the year following diagnosis and on only 1/3 measures for five-year survivors.[3] We have also examined the quality of comorbid condition care in breast, prostate, and colorectal cancer survivors during Days 366-1095 post-cancer-diagnosis. We found PCP visits were associated with appropriate care for 3/3 chronic condition indicators and 1/5 acute care indicators; oncology specialist visits were associated with appropriate care on 2/3 chronic indicators and worse care on 1/5 acute indicators.[4]

In addition to this quantitative work, our group has also conducted qualitative focus group research on this topic. Specifically, Kantsiper et al[5] conducted focus groups with breast cancer survivors (as well as oncology specialists and PCPs) examining their perspectives on the transition from active treatment to survivorship. Our findings echo the themes reported by Hudson and colleagues, including the bonds formed between survivors and their cancer doctors and survivors' concerns about their PCPs' expertise to address cancer issues.

Perhaps if we begin managing expectations from the time of diagnosis, emphasizing that (1) cancer may not end up being patients' most important health issue and (2) non-cancer care is likely to be better if a PCP is involved, we can educate patients (and their doctors) so that all know what they might be missing.

1. Snyder CF, Frick KD, Kantsiper ME, Peairs KS, Herbert RJ, Blackford AL, Wolff AC, Earle CC. Prevention, Screening, and Surveillance Care for Breast Cancer Survivors vs. Controls: Changes from 1998-2002. Journal of Clinical Oncology. 2009;27:1054-61.
2. Snyder CF, Frick KD, Peairs KS, Kantsiper ME, Herbert RJ, Blackford AL, Wolff AC, Earle CC. Comparing Care for Breast Cancer Survivors to Non-Cancer Controls: A Five-Year Longitudinal Study. Journal of General Internal Medicine. 2009;24:469-74.
3. Snyder CF, Frick KD, Herbert RJ, Blackford AL, Neville BA, Carducci MA, Earle CC. Preventive Care in Prostate Cancer Patients: Following Diagnosis and for Five-Year Survivors. Journal of Cancer Survivorship. 2011;5:283-291.
4. Snyder CF, Frick KD, Herbert RJ, Blackford AL, Neville BA, Wolff AC, Carducci MA, Earle CC. Factors Associated with Quality Comorbid Condition Care during the Transition to Cancer Survivorship. 6th Biennial Cancer Survivorship Research Conference. June 14-16, 2012. Arlington, Virginia.
5. Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC. Transitioning to Breast Cancer Survivorship: Perspectives of Patients, Cancer Specialists, and Primary Care Providers. Journal of General Internal Medicine. 2009;24 Suppl 2:S459-66.

Competing interests:   None declared