The Importance of Including Primary Care Physicians in a Patient's Cancer Journey

“How do you currently collaborate with your primary care colleagues in caring for patients with cancer?” This was how Larissa Nekhlyudov, MD, MPH, opened the session, “Bringing the Primary Care Physician Back Into Cancer Care,” during the American Society of Clinical Oncology’s Annual Meeting, held in Chicago, Illinois from May 31- June 4, 2019.

Answers to Nekhlyudov’s question ranged from communication through electronic health record (EHR) systems, to picking up the phone and calling the primary care physician (PCP), though one thing remained consistent throughout every answer: we need to be doing better.

Nekhlyudov was joined by panelists Piyush Srivastava, MD, gastrointestinal medical oncologist at Kaiser Permanente; Trevor Jolly, MBBS, medical oncologist at UNC Health Care; and Elizabeth Schiff, a patient advocate and 2-time cancer survivor, to discuss and present interactive case studies where PCPs should be a part of the conversation.

The first case involved a 75-year-old post-menopausal female with newly diagnosed screen detected left-sided invasive breast cancer; her medical history included a body mass index of 31.4 and several years of hypertension. The audience and panelists were asked which medical condition was most likely to cause the patient’s death in the next 10 years. Most answered cardiovascular disease, as one of the highest risk factors for cardiovascular disease is hypertension. However, when the audience was asked who they would prefer to manage the patient’s blood pressure and other cardiovascular disease risk factors, a cardiologist or a PCP, most preferred a PCP.

This surprised Nekhlyudov, who expected most audience members to recommend a cardiologist. She presented data from a study published in JAMA in February 2019, which found that PCPs “have a huge effect on mortality for cancer patients. Every 10 additional PCP per 100,000 population is associated with 51.5 extra days of life expectancy, versus 19.2 days for additional specialists. Also, every 10 additional PCPs per 100,000 population was associated with reduced cardiovascular, cancer, and respiratory mortality by 0.9% to 1.4%,” said Nekhlyudov.

Jolly couldn’t agree more regarding the importance of a primary care physician in a cancer patient’s journey. He explained that what he often sees in practices is that, as with the case study, the oncologist will let the PCP deal with the hypertension, and the oncologist will deal with the cancer. “But we need to collaborate more. If you see that your patient has hypertension, call her physician. Bring it to their attention. Ask them to follow up if you started her on a hypertension medication. That communication is key.”

Though the panelists and the audience seemed to be in agreement on this matter, 1 audience member brought up a point that had not yet been mentioned: “You haven’t addressed the medical economics of these visits. Some patients have a copay, and they can’t afford to see their primary care physician as often as they see their oncologist during active treatment.”

Schiff agreed. Having been through her own cancer journey, she explained that she knew the care coordination could get complicated. “If you need to choose between seeing your oncologist and seeing your PCP, well, that would be hard. If you’re in active treatment, I would imagine you’d see your oncologist. But this is where the communication between the oncologist and the PCP is essential. If the patient can only economically see the oncologist on a regular basis, that oncologist needs to communicate with the PCP to make sure they’re kept up to date on the patient’s treatment journey and condition.”

When asked to describe ways to improve communication between PCPs and oncologists, the overarching responses included creating an integrated EHR system across the different providers and needing more time to meet with each patient.