Views of health professionals on the role of primary care in the follow-up of men with prostate cancer

Abstract

Background. Follow-up care for prostate cancer has traditionally been led by secondary care in hospital out-patient clinics. As the number of men with prostate cancer increases and secondary care resources face pressure, alternative follow-up models are being sought. Current National Institute for Health and Clinical Excellence guidance recommends follow-up outside the hospital setting for patients who are stable 2 years following radical treatment and for those undergoing 'watchful waiting'. Objective. To describe current practice in a sample of relevant health care professionals and to seek their views on the role of primary care in prostate cancer follow-up.Methods. Semi-structured telephone interviews with 38 UK health care professionals, from both secondary and primary care. Transcripts were analysed using the constant comparative method.Results. There are marked variations in current follow-up practice around the country, with hospital-based follow-up ranging from 6 months to lifetime. The predominant, although not universal, view expressed was that there is both scope and support for primary care to play a greater role, particularly for men with stable disease. This was qualified by the need for supporting education, including guidance on interpretation of prostate-specific antigen values, introduction of robust follow-up systems in primary care, easy access back into secondary (hospital) care, a mechanism for ensuring follow-up data can still be collected for audit purposes and appropriate resourcing. Conclusions. If primary care is to play a significant role in providing high-quality follow-up care for men with prostate cancer, then steps need to be taken to address the barriers to increased primary care involvement identified by this study.

The expanding role of primary care in cancer control

“…Studies have shown willingness from PCPs and support from secondary care for increased primary care involvement in follow-up, provided that adequate guidelines, educational support (knowledge and skills), clear lines of communication with easy access back to secondary (hospital) care, robust monitoring systems in primary care, and adequate resourcing are available. 190,191 Patients recognise the potential benefi ts in terms of convenience, familiarity, and knowledge of comorbidities and family situation off ered by primary care, but they express concerns about PCPs having the level of knowledge needed. 191 Nevertheless, some patients gain considerable reassurance from followup care delivered in hospital settings.…”

“…190,191 Patients recognise the potential benefi ts in terms of convenience, familiarity, and knowledge of comorbidities and family situation off ered by primary care, but they express concerns about PCPs having the level of knowledge needed. 191 Nevertheless, some patients gain considerable reassurance from followup care delivered in hospital settings. It has been acknowledged that patients are not well informed about the evidence of limited benefi t for conventional follow-up schedules and that their preferences might change if the evidence was more widely understood.…”

Follow-up in Gynecological Malignancies: A State of Art

“…6 The specialists have a thorough knowledge of cancer and easier access to imaging and laboratory tests, but some of these tests are often unnecessary, and they only raise anxiety of patients, focusing on their illness and not on their wellness. 7 General gynecologists may play an intermediary role between the specialist and general practitioner.…”

“…An effort should be done to promote better communication and cooperation between specialists and general practitioners for transferring follow-up care from hospital to the community. 7 Randomized clinical trials (RCTs) comparing the role of specialist and general practitioner in low stage breast cancer showed no difference in recurrence rate, death rate, and QoL, 8,9 but higher satisfaction in patients followed by their general practitioner. 10 Moreover breast cancer follow-up by the general practitioner was less costly than routine hospital follow-up, by a mean of U130 (179 €; 198 $) per patient.…”

PROSPECTIV—a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial

“…Studies have also shown that healthcare professionals involved in secondary (hospital-based) and primary (general practitioner (GP) clinic-based) care see a greater role for primary care in delivering follow-up care,13 and that this would be acceptable to men with prostate cancer 6. A recent literature review found no significant differences in patient outcomes in primary versus secondary care follow-up for breast and bowel cancer 14.…”