Originally published as JCO Early Release 10.1200/JCO.2008.20.4883 on April 20 2009

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Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors

From the Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre; Ontario Institute of Cancer Research and Cancer Care Ontario, Health Services Research Program; and Divisions of Hematology and Medical Oncology, Department of Medicine, Odette Cancer Centre, Toronto, Ontario, Canada.

Corresponding author: M. Elisabeth Del Giudice, MD, CCFP, Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, A112, 2075 Bayview Ave, Toronto, Ontario, Canada, M4N 3M5; e-mail: lisa.delgiudice{at}sunnybrook.ca.

Purpose Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.

Methods A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.

Results A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.

Conclusion With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.

Supported by Dean's Fund, New Staff Grant, Faculty of Medicine, University of Toronto.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL; National Cancer Institute of Canada's 60th Anniversary, "Making Connections: A Canadian Cancer Research Conference," November 16, 2007, Toronto, Ontario, Canada; Inaugural Meeting of the International Primary Care and Cancer Research Group, April 24-25, 2008, Edinburgh, Scotland; and Trillium Primary Care Research Day, June 20, 2008, Toronto, Ontario, Canada.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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