Photo courtesy of NIH
Doctor and patient
Primary care may not meet the healthcare needs of cancer survivors in the US, according to research published in JAMA Internal Medicine.
Researchers examined 12 advanced primary care practices selected from a national registry of “workforce innovators” and found that none of these practices had a comprehensive survivorship care program in place.
In addition, there were 3 main barriers to survivorship care—not treating cancer survivors as a distinct population, limitations of electronic health records, and a lack of information and guidance for clinicians.
“This is troubling because these are highly innovative practices that have a national reputation,” said study author Benjamin Crabtree, PhD, of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.
Dr Crabtree and his colleagues evaluated survivorship care* at the 12 practices, which were based in Colorado, Illinois, Maine, New York, Pennsylvania, and Washington.
Over nearly 2 years, the team spent 10 to 12 days observing each of the practices and interviewing clinicians and administrators.
In this way, the researchers identified 3 main barriers to integrating survivorship care into primary medicine.
Barrier 1
The first barrier was that clinicians did not treat cancer survivors as a distinct population or clinical category.
“There is no diagnosis code for ‘cancer survivor’ that can be entered into the medical record, which is important if you want physicians to pay attention,” Dr Crabtree said.
Some of the clinicians interviewed said their care was comprehensive enough to address the needs of all patients. Other clinicians did not understand what survivorship care entails.
Barrier 2
The second barrier was that electronic health record systems didn’t support survivorship care.
Clinicians reported an inability to identify patients with a history of cancer. Even if a patient’s cancer history was included in his or her record, it might take searching through multiple screens to find the information.
In addition, medical records were sometimes lost as patients changed clinicians over the years, which left it up to patients to report their cancer histories.
Barrier 3
The third barrier was that clinicians did not receive adequate information or guidance for follow-up care of cancer survivors.
Although some of the practices received cancer-related information about their patients, it was considered “inadequate” or “not actionable.”
Clinicians expressed concerns about their knowledge gaps in cancer care and the need to monitor changing information in oncology.
“There is nothing in the residency curriculum about cancer survivorship,” Dr Crabtree said. “There is also nothing in Continuing Medical Education courses. It’s just not there.”
Dr Crabtree and his colleagues believe these barriers must be addressed so that comprehensive cancer survivorship services can move to the forefront of primary care.
* Survivorship care includes checking for cancer recurrence, monitoring long-term effects of radiation and chemotherapy, and assessing a patient’s psychological well-being.