I have posted a number of previous notes about cancer survivorship (see: Cancer Survivorship, an Emerging Subdiscipline in Oncology; "Chemo Brain" Can Persist for Three to Five Years; Exercise Can Help Reverse; New Research Casts Spotlight on "Chemo Brain"). However, I have not given much thought to exactly which physicians would administer long-term care to cancer survivors. A recent article addressed this topic (see: Study: Doctors differ in how best to care for America's 12 million cancer survivors). Below is an excerpt from it:
There are major differences between oncologists and primary care physicians regarding knowledge, attitudes, and practices required to care for American's 12 million cancer survivors. That is the key finding of the first nationally representative survey of doctors that reveals how these differences pose significant barriers to effective communication and coordination of care following initial cancer treatment. The study...included results of a survey of 1,072 primary cancer physicians (PCP) and 1,130 oncologists randomly sampled from among all U.S. practicing physicians during 2009. The authors say the findings are of considerable concern, given the rapidly increasing cancer survivor population and looming shortages of both oncology specialists and primary care physicians who will be needed to provide care to this population. Because many individuals stop seeing their oncologist after the first few years following their initial cancer treatment, primary care doctors often assume a large share of providing care to survivors. Optimal cancer survivorship care includes not only surveillance for recurrence or second cancers, but also addressing the long-term and late medical effects of cancer or its treatment, providing psychosocial support, and managing other diseases or conditions. Several factors may present challenges to ensuring a smooth transition for survivors as they move from initial acute care to post-treatment care...."What the survey tells us is that many doctors, particularly primary care doctors don't have a high level of confidence in their own knowledge of some aspects of survivorship care, and many oncologists believe that PCPs are not adequately prepared to provide such care. We also see some evidence of knowledge deficits in both physician groups in terms of guideline-based care for survivors," [the study author] says.
First of all, this article succinctly highlights the key elements of the care of cancer survivors that I now repeat for emphasis:
- Surveillance for recurrence or second cancers
- Addressing the long-term and late medical effects of cancer or its treatment
- Providing psychosocial support for the patient
- Managing other diseases or conditions of the patient
I don't think that it's a good idea to disrupt the relationship of cancer survivors with their PCPs. Hence, this last item, managing other diseases or conditions of the patient, should obviously be the responsibility of this set of physicians. However, I think that the first three items in this list would be best managed within cancer centers. I understand that they may not be viewed as goals currently embraced by such centers. Cancer care has increasingly become more and more specialized. Hence, the observation of the study regarding primary care physicians: [they] don't have a high level of confidence in their own knowledge of some aspects of survivorship care. It also seems to me that survivorship research would be greatly enhanced if carried out to some extent in cancer centers.