Quality Improvement
Megan Delisle, MD MPH
Complex General Surgical Oncology Fellow
University of Ottawa
Ottawa, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Cancer survivorship follow-up led by primary care providers (PCP) is safe and effective compared to traditional oncologist-led care. Survivorship care plans (SCP) provide follow-up recommendations to strengthen PCP-led follow-up. The aim of this study is to describe differences in experiences with cancer follow-up among cancer survivors based on physician specialty and SCP.
Methods:
A national survey was conducted in 2016 to identify experiences with cancer follow-up among cancer survivors who completed treatment. We excluded patients < 18 years old, unknown cancer type, metastatic disease and missing data on primary exposure or outcome. A multivariable logistic regression controlling for sociodemographic and clinical characteristics was used to assess the association between PCP- vs. oncologist-led follow-up, SCPs and rating overall experiences with follow-up care as good or very good versus fair, poor or very poor.
Results:
A total of 40,790 surveys were distributed across ten provinces and 13,258 (33.3%) were completed. A total of 7,303 were included in our analysis. Follow-up was provided by oncologists alone (3,115, 42.7%), PCPs alone (1,638, 22.4%), both PCP and oncologists (2,310, 31.6%) and no one (240, 3.3%). SCPs were provided to 3,589 patients (49.1%).
Patients with oncologist- vs. PCP-led follow-up were more likely to report increased satisfaction with overall care (OR 3.2 95% CI 2.6-3.9), access to the right services (OR 2.7 9% CI 2.2-3.2) and personalized care (OR 2.7 95% CI 2.2-3.2). Patients with an SCPs were more likely to report increased satisfaction with overall care (OR 3.7 95% CI 3.1-4.4), access to the right services (OR 3.1 95% CI 2.6-3.7) and personalized care (OR 3.7 95% CI 3.2-4.3). Patients with SCPs were more likely to report PCP involvement in follow-up (2,114 53.6% vs. 1,834 46.5% p< 0.01).
Conclusions:
Oncologist-led cancer follow-up and SCPs are independently associated with increased patient satisfaction. SCPs are associated with increased PCP involvement. Additional research to strengthen PCP-led cancer follow up is required in the context of rising cancer incidence and increasingly constrained cancer system.