Family Physician Involvement in Cancer Care Follow-up: The Experience of a Cohort of Patients With Lung Cancer

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Figure 1.
Patient participation in the study.

Table 1.

Patient Characteristics at Baseline (N=395)

Characteristic	No. (%) or Mean ± SD (Range) [Median]
Sex
Female	170 (43.0)
Male	225 (57.0)
Functional status
Normal activity	178 (45.1)
Symptoms but ambulatory	150 (37.9)
Confined to bed or chair <50% of waking hours	44 (11.1)
Confined to bed or chair ≥50% of waking hours	20 (5.1)
Completely disabled—100% bedridden	3 (0.8)
Type of lung cancer
Squamous cell carcinoma	77 (19.5)
Adenomatous carcinoma	164 (41.5)
Other non–small cell carcinoma	67 (17.0)
Small cell carcinoma	58 (14.7)
Unknown	29 (7.3)
Treatment
Surgery with/without chemotherapy/radiation therapy	113 (28.6)
Chemotherapy and/or radiation therapy	254 (64.3)
No treatment	28 (7.1)
Metastases
Present at baseline	128 (32.4)
Found during follow-up	37 (9.4)
None	230 (58.2)
Cancer stage
Stage I	56 (14.2)
Stage II	33 (8.3)
Stage III	119 (30.1)
Stage IV	133 (33.7)
Not confirmed	54 (13.7)
Age, years	63.4 ± 9.5 (31–88) [64]
Education, years	10.9 ± 3.9 (2–24) [11]
Intervals in care
Investigation to diagnosis, weeks	5.6 ± 8.0 (0–78) [3]
Diagnosis to first treatment, days	29.0 ± 26.6 (0–140) [21]

Table 2.

Extent of Family Physician Involvement by Cancer Phase

Extent of Involvement	N (% of Patients)	PValue^a
^a From the Cochran-Mantel-Haenszel test; compares, across cancer phases, the proportion of patients who reported each extent of family physician involvement.
^b Only for patients who had treatment.
^c This question was not asked at the diagnosis phase; often, treatment had already begun at the baseline interview.
Contact with family physician
Diagnosis	364 (58.8)	<.001
Primary treatment	108 (60.2)
Stability	228 (88.2)
Progression/relapse	48 (75.0)
Advanced/terminal	37 (67.6)
If contact with family physician, discussion about visits to oncologist
Diagnosis	214 (72.9)	.09
Primary treatment	65 (77.8)
Stability	197 (79.7)
Progression/relapse	36 (91.7)
Advanced/terminal	22 (83.3)
Questions to ask of family physician in relation to cancer
Diagnosis	214 (32.7)	<.001
Primary treatment	65 (43.1)
Stability	201 (44.3)
Progression/relapse	36 (50.0)
Advanced/terminal	25 (64.0)
Family physician involvement in treatment decisions^b
Diagnosis^c	–	<.001
Primary treatment	53 (15.1)
Stability	107 (16.8)
Progression/relapse	34 (20.6)
Advanced/terminal	13 (53.9)

Table 3.

Family Physician Involvement in Various Aspects of Care by Cancer Phase

Aspect of Care	Actual Involvement N (% of Patients)	Expected Involvement N (% of Patients)	PValue^a
^a From the χ² test; compares, at each cancer phase, the actual vs expected proportions for family physician involvement in specific aspects of cancer care, as reported by patients.
Coordination of care
Diagnosis	357 (41.2)	362 (83.4)	<.001
Primary treatment	102 (24.5)	107 (83.2)	<.001
Stability	227 (31.3)	228 (85.1)	<.001
Progression/ relapse	46 (37.0)	48 (75.0)	<.001
Advanced/terminal	37 (46.0)	37 (86.5)	<.001
Emotional support
Diagnosis	351 (36.8)	362 (83.4)	<.001
Primary treatment	104 (44.2)	107 (86.9)	<.001
Stability	227 (54.6)	228 (88.2)	<.001
Progression/relapse	46 (60.9)	48 (87.5)	.002
Advanced/terminal	37 (51.4)	37 (81.1)	.007
Transmission of information
Diagnosis	352 (17.3)	362 (62.0)	<.001
Primary treatment	103 (18.4)	107 (59.8)	<.001
Stability	227 (29.1)	228 (72.4)	<.001
Progression/ relapse	46 (34.8)	48 (58.3)	.01
Advanced/terminal	37 (37.8)	37 (73.0)	.002
Symptom relief
Diagnosis	332 (13.0)	361 (62.3)	<.001
Primary treatment	100 (19.0)	107 (74.8)	<.001
Stability	225 (30.2)	228 (79.8)	<.001
Progression/relapse	46 (30.4)	48 (72.9)	<.001
Advanced/terminal	37 (43.2)	37 (78.4)	.002

Table 4.

Family Physician Pattern of Care by Cancer Phase

	Cancer Phase
Pattern of Care	Diagnosis (N=395)	Primary Treatment (n=118)	Stability (n=238)	Progression/Relapse (n=50)	Advanced/Terminal (n=39)	PValue^a
Note: Values are percentages of patients.
^a From the Cochran-Mantel-Haenszel test; compares variation of each family physician pattern of care across cancer phases.
No family physician	7.8	8.5	4.2	4.0	5.1	.31
Sequential	11.6	12.7	3.8	2.0	18.0	<.001
Parallel	64.6	54.2	55.9	62.0	23.1	<.001
Shared	16.0	24.6	36.1	32.0	53.8	<.001

Table 5.

Patient Visits to Their Family Physician by Cancer Phase and Pattern of Care^a

	Pattern of Care
Cancer Phase	No Family Physician	Sequential	Parallel	Shared Care	PValue^b
Note: Values are mean ± standard deviation number of visits.
^a Values should not be compared from one cancer phase to another since duration of each phase was not equivalent.
^b From analysis of variance; compares, at each cancer phase, the mean number of visits to the family physician according to family physician patterns of care.
Primary treatment	–	0.00	0.89 ± 1.38	2.25 ± 1.73	<.001
Stability	–	0.00	1.28 ± 1.26	2.54 ± 2.52	<.001
Progression/relapse	–	0.72 ± 0.00	1.33 ± 1.48	3.21 ± 3.27	.02
Advanced/terminal	–	0.67 ± 0.82	1.20 ± 1.81	2.37 ± 1.30	.02