Posttreatment Care in Breast Cancer: Oncologist vs PCP Roles

Provider roles in team-based care in oncology need clarity, and now, results from a new study affirm the confusion experience by patients treated for breast cancer on who should lead their care posttreatment.

The study, published in the Journal of Clinical Oncology, surveyed 2372 women with newly diagnosed stage 0 to II breast cancer who were treated in 2014 and 2015. The data were acquired from Surveillance, Epidemiology, and End Results registries in Georgia and Los Angeles county on women who had a primary care doctor and who agreed to participate in a survey that inquired on:

• Follow-up mammograms
• Screening for other cancers
• General preventive care
• Comorbidity management

The primary question being assessed was patient preferences for provider roles: oncology-directed care versus primary care provider (PCP)—directed care, and the influence of patient demographic factors on their choice of care provider.

“There’s a concern that there aren’t clear enough delineations of roles for the providers and who’s delivering what care” for survivors, said Lauren Wallner, PhD, assistant professor at the University of Michigan, and lead researcher on the study. “If patients prefer to go to their oncologist for types of care that a primary care provider normally delivers, there is a chance that patients might not get that care.”

The study found that a majority of women leaned toward their PCP being in charge of preventive (79%) and comorbidity (84%) care—only 21% chose their oncologist to guide preventive care and an even smaller number (16%) chose their oncologist over the PCP for comorbidity care. Race and education were 2 important determinants of who the women chose as their go-to for posttreatment care: minority women (black and Asian) and women with a high school education or less preferred that their oncologist direct their preventive care (black odds ratio [OR], 2.01; 95% CI, 1.43 to 2.82; Asian OR, 1.74; 95% CI, 1.13 to 2.69; high school education or less OR, 1.51; 95% CI, 1.10 to 2.08).

A similar trend was noted for comorbidity care among these women. An important point to note is that these preferences were seen even though two-thirds of study participants had been with their current PCP for more than 2 years, and about three-fourths had seen the PCP at least once since their cancer diagnosis.

Noting the trends presented by their study, the authors emphasize the need to clarify provider roles in survivorship care to improve team-based care in patients with care.

Wallner noted that despite the personal nature of the decision, patients might fall through the cracks as far as their routine care is concerned if they wait for their oncologist to provide prescriptions that are outside their normal focus. She added that changes can be triggered with better education, communication, and clear clinical guidelines so both, healthcare providers and patients are comfortable with the transition back to primary care and letting PCPs handle aspects of follow-up care more traditionally associated with oncology.

Reference

Wallner LP, Li Y, Furgal A, et al. Patient preferences for primary care provider roles in breast cancer survivorship care [published online July 12, 2017]. J Clin Oncol. doi: 10.1200/JCO.2017.73.1307.