Who should provide follow-up care for cancer survivors?

The rise in cancer survivors, coupled with a looming shortage of oncologists, is expected to increase the number of former cancer patients seeking follow-up treatment from primary care physicians.

But some primary care doctors question their ability to care adequately for such patients, and oncologists share those concerns, says a study published online July 22 in the Journal of General Internal Medicine.

Fifty-nine percent of primary care doctors strongly or somewhat agree that primary care physicians have the necessary skills to provide follow-up care to survivors of breast and colon cancer. Forty percent feel "very confident" about the appropriate tests for detecting recurrent disease in these patients, the study shows. Cancer survivors have an increased risk of developing recurrent cancer or a second type of cancer, said the Centers for Disease Control and Prevention.

Among oncologists, only 23% somewhat or strongly agree that primary care doctors have the necessary skills to care for cancer survivors.

The study's authors recommend that primary care doctors receive more training and education on follow-up cancer care. The report also advocates for better communication between oncologists and primary care doctors to ensure that they have sufficient information about a patient's cancer treatment and health issues.

"Often, after four or five years [of being disease-free], survivors stop seeing the oncologist and are in the primary care system," said lead study author Arnold L. Potosky, PhD, director of health services research at Georgetown University, Lombardi Comprehensive Cancer Center in Washington. "If primary care doctors are going to have to take on these responsibilities, but oncologists don't have a great amount of confidence that they can do this, and even PCPs aren't sure, that means something needs to be done."

One in three Americans develops cancer, and nearly 12 million are survivors of the disease, according to the study. The growing number of survivors, which is nearly four times greater than it was in 1971 (3 million people), is due largely to improved screening and treatment, the CDC said.

Survivors often have long-term effects of their cancer treatment, including chronic pain, depression and cardiotoxicity. Thus, the study authors said physicians should feel comfortable screening these patients for recurrent and second cancer, as well as addressing the long-term medical effects of the disease, providing psychosocial support and managing other standard health conditions.

Researchers in 2009 surveyed a nationally representative sample of physicians -- 1,072 primary care doctors and 1,130 medical oncologists -- about their attitudes regarding the care of breast and colon cancer survivors. The survey asked physicians to select their preferred model for follow-up care for cancer survivors -- care led by primary care physicians, treatment primarily by oncologists, shared responsibility between the two groups, specialized clinics led by physicians or a clinic led by oncology nurses, certified nurse practitioners or physician assistants.

Respondents also rated their confidence in caring for cancer survivors and made cancer surveillance recommendations based on hypothetical clinical vignettes.

Researchers found that 38% of primary care physicians favor sharing the responsibility of caring for cancer survivors with oncologists. One in four primary care doctors thinks oncologists should have the primary responsibility, and 10% prefer a care model led by primary care physicians.

Among oncologists, 57% prefer being the lead caregiver, 16% favor a share-care approach and 2% want primary care physicians to be responsible for the treatment.

Both groups of physicians recommended more cancer screening at more frequent intervals than guidelines suggest. As a result, the study authors recommend additional training on appropriate posttreatment surveillance testing for all physicians.

"More training and education on cancer survivorship is critical for the primary care physician and the oncologist," said Julia Rowland, PhD, co-author of the study and director of the Office of Cancer Survivorship at the National Cancer Institute. She said such training could include identification of who may be best equipped to provide different aspects of care.