Primary care physicians provide most medical care for cancer survivors

Study examines physician roles in current specialist-driven models of care.

Primary care physicians, not oncologists, are the main providers of health care for cancer survivors.

A new study examined who was providing most of the care for cancer survivors, and 68.3% of patients reported they get their subsequent health care from family physicians (42.3%) and general internists (26%). Subspecialists provided the care for 28.4% of survivors, according to the study, “Growing Need for Primary Care Physicians Caring for Cancer Survivors,” published as original research in the Journal of the American Board of Family Medicine.

Among survivors, 44.2% recalled being given written summaries of their treatment. “Recognizing findings in the present study, more will need to be done to encourage consistent communication between the oncology team, physician to whom care is transferred, and the engaged patient,” the study said.

Authors Imam M. Xierali, PhD, and William F. Rayburn, MD, MBA, called for new collaboration between primary care physicians and oncologists to heal patients and to treat cancer if it returns.

“Primary care, along with oncology and other subspecialties, should coproduce and translate new knowledge within a shared decision making framework to optimize care,” the study said. “These collaborative efforts will require an open dialog between the oncology team and those practitioners who provide more accessible and community-based care for these individuals with special needs.”

The study noted several factors affecting medical care for cancer survivors. Their numbers are growing in the United States, but there is a shortage of oncology services for continuity of care after treatment, reducing the sustainability of specialist-based care, the study said.

For less common cancers such as leukemia/lymphoma, thoracic, and head and neck, subspecialists such as various cancer surgeons, oncologists, gynecologists or urologists, offered continuity of care for survivors. Primary care physicians are more likely to see survivors of more common cancers – skin, breast, female reproductive and male reproductive cancers, the study said.

“The highest percentages of primary care givers were in less densely populated and less urban states,” the study said. In 13 states – Virginia, West Virginia, Alabama, Michigan, Wisconsin, Iowa, Missouri, Arkansas, South Dakota, Nebraska, Kansas, Oklahoma, and New Mexico – they were providing care for up to 79.6% of cancer survivors.

The researchers suggested more education and experience for the primary care physicians to learn about cancer treatment.

“Unlike care for patients with heart disease or diabetes, long-term care for cancer survivors is currently not integral in medical school education or primary care residency training,” the study said. “Our results strengthen the need for integrating cancer survivorship topics into residency education.”

Postgraduate work in “shadowing at cancer centers to bolster patient and oncologist receptivity in collaborating and transitioning into continuity care,” the study said.

The research was based on a telephone survey of 36,737 survivors across 33 states in the period 2016 to 2020, through the Behavioral Risk Factor Surveillance System, developed by the federal Centers for Disease Control and Prevention. The researchers noted the findings may not represent the entire U.S. population of cancer survivors. Skin cancer was the most common form reported by the survivors “and likely includes those that are easily curable,” the study said.