Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer

Abstract

Adult and adolescent survivors of childhood cancer who receive their follow-up care from a family physician must be empowered to choose a physician who is comfortable with caring for survivors. Further, the survivor must ensure that their physician has access to a treatment summary as well as to patient-specific recommendations for surveillance for late effects of cancer therapy.

Primary Care Physicians’ Perspectives of Their Role in Cancer Care: A Systematic Review

“…56,58,60,62,69,70 PCPs suggested improving post-treatment follow-up through a shared data management system, 53 such as the broad integration of electronic medical records and standard communication procedures between PCPs and specialists. 65,70 Provision of patient-specific standard guidelines notated by oncologists 40,44,48,59,69 or meetings aimed at sharing information and defining roles 38 were also endorsed. Electronic communication and mail were valued, 40,58,65,69 but not to the exclusion of personal interaction with specialists, which was preferred.…”

“…69 For the management of paediatric cancer survivors, one study reported that 30-40 % of PCPs had participated in a conversation with a colleague about survivorship care, participated in medical education activities, or read one or more survivorship articles, and approximately 20 % had experienced formal training, possibly as distant as during their undergraduate studies. 59 lack of time and workload pressure, 49,52,64,71,72 lack of remuneration and inadequate funding, 49,52,72 lack of patient trust, 44,64 inadequate resources including cancer-specific guidelines and opportunities for mental health or multi-disciplinary referrals 40,47,52,60,69 and increased medicolegal risk. 72 Qualitative and quantitative results are summarized in Table 3.…”

“…39 However, conclusive evidence has not yet determined which model may be most effective. PCPs have indicated an interest in increasing their role in cancer patient care 39,42,46 ; however, PCPs' limited confidence 38,40,54,60,61 and ability 40,49,52,59,64,66,71 to perform the various roles pose a challenge. It appears that PCP confidence levels fluctuate along the cancer care continuum and according to the type of care needed.…”

“…This may be attributed to PCPs' reports of minimal formal training in survivorship care, the lack of appropriate guidelines, insufficient contact with oncologists and insufficient experience. 30,38,40,50,59,69 Improving PCP confidence to deliver cancer care is critical before a model of shared care is recommended.…”

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

“…Many feel unprepared to take on postcancer care independently. [40][41][42] In a hybrid model, PCPs share care with a cancer center team that provides guidance on cancer-related issues. No studies compare effectiveness of these models.…”