Research Finds Cancer Survivorship Care Lacking in Advanced Primary Care Practices

A new case study of 12 advanced primary care practices finds that none provided comprehensive cancer survivorship care, which the authors attributed to insufficient information systems and difficulties identifying survivors.

According to the research, published in JAMA Internal Medicine, primary care practices overseas have seen the benefits of providing high-quality cancer survivorship care to their patients, but few studies have examined whether these models have been integrated into community-based primary care settings in the United States. By conducting a case study of 12 such practices, the researchers hoped to evaluate the extent of integration as well as any barriers to further implementation.

Of the 12 practices in the study, all but 3 were recognized as level 3 patient-centered medical homes by the National Committee for Quality Assurance. Researchers conducted interviews with practice staff and leadership and also directly observed practice workflows. Staff were asked about the general culture at the practice as well as more specific questions about cancer survivorship care.

The researchers observed that none of the practices provided comprehensive cancer survivorship services, and they identified 3 main barriers to implementing such care. First, clinicians were confused about what made cancer survivorship a distinct clinical category, as many reported treating cancer survivors like any other patient with a history of chronic illness. Patients with cancer often did not receive follow-up from primary care after being referred to oncology, and “survivorship remained a concept with little practical meaning in the primary care setting,” the authors wrote.

Also, the primary care clinicians reported not having enough information about the treatments their patients received for cancer at other sites. Commonly, treating oncologists did not provide recommendations for long-term survivorship care, which would have helped the primary care practices create a care plan for these patients.

Finally, the practices’ electronic health record systems did not allow them to identify and track patients with a history of cancer. Clinicians reported that relevant notes about cancer diagnoses and survivorship plans were often buried deep in the patients’ records, which puts them at risk of being overlooked. As they were not able to track cancer survivors, they found it difficult to estimate the size of their patient population who had survived cancer and potentially target interventions to this group.

“Despite the push from national organizations to enhance cancer survivorship care capacity in primary care, findings from this study suggest that cancer survivorship care does not integrate easily into advanced primary care,” the study authors summarized.

Future efforts to advance the integration of survivorship care could include developing a clinical code for cancer survivors and providing actionable care strategies for primary care clinicians to follow up with these patients.

By addressing the 3 barriers observed in the case study practices, “comprehensive cancer survivorship services could more easily integrate into current primary care transformation efforts,” the researchers concluded.