JCO Early Release, published online ahead of print Mar 30 2009
Journal of Clinical Oncology, 10.1200/JCO.2008.20.3232
Received September 25, 2008
Accepted December 3, 2008
Comparisons of Patient and Physician Expectations for Cancer Survivorship Care
Winson Y. Cheung, Bridget A. Neville, Danielle B. Cameron, E. Francis Cook, and Craig C. Earle*
From the Harvard School of Public Health; Center for Outcomes and Policy Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: craig.earle{at}ices.on.ca
Purpose: To compare expectations for cancer survivorship care between patients and their physicians and between primary care providers (PCPs) and oncologists.
Methods: Survivors and their physicians were surveyed to evaluate for expectations regarding physician participation in primary cancer follow-up, screening for other cancers, general preventive health, and management of comorbidities.
Results: Of 992 eligible survivors and 607 physicians surveyed, 535 (54%) and 378 (62%) were assessable, respectively. Among physician respondents, 255 (67%) were PCPs and 123 (33%) were oncologists. Comparing patients with their oncologists, expectations were highly discrepant for screening for cancers other than the index one (agreement rate, 29%), with patients anticipating significantly more oncologist involvement. Between patients and their PCPs, expectations were most incongruent for primary cancer follow-up (agreement rate, 35%), with PCPs indicating they should contribute a much greater part to this aspect of care. Expectations between patients and their PCPs were generally more concordant than between patients and their oncologists. PCPs and oncologists showed high discordances in perceptions of their own roles for primary cancer follow-up, cancer screening, and general preventive health (agreement rates of 3%, 44%, and 51%, respectively). In the case of primary cancer follow-up, both PCPs and oncologists indicated they should carry substantial responsibility for this task.
Conclusion: Patients and physicians have discordant expectations with respect to the roles of PCPs and oncologists in cancer survivorship care. Uncertainties around physician roles and responsibilities can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
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