Originally published as JCO Early Release 10.1200/JCO.2008.18.0679 on January 12 2009

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Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients

From the Departments of Family Medicine and Community Health and Medicine, Center for Clinical Epidemiology and Biostatistics, and Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA.

Corresponding author: Jun J. Mao, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania, 2 Gates Bldg, 3400 Spruce St, Philadelphia, PA 19104; e-mail: jun.mao{at}uphs.upenn.edu.

Purpose Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care.

Patients and Methods We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery.

Results Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both).

Conclusion Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.

Supported in part by Grants No. IRG-78-002-30 and CCCDA-08-107-01 from the American Cancer Society and by the Lance Armstrong Foundation.

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

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