Who Leads Long-Term Breast Cancer Survivor Care?

TOPLINE:

Over half of breast cancer survivors (57.2%) report oncologist-led care more than 5 years posttreatment, while only 22.4% receive Primary Care Provider (PCP)-led care. Patient confidence in PCP ability to manage survivorship care is linked to increased PCP involvement.

METHODOLOGY:

• There are currently 4.1 million breast cancer survivors in the United States, and national organizations have advocated for increased PCP involvement with cancer survivors to address the challenges of delivering care to these patients.
• Evidence suggests that survivorship care primarily delivered by PCPs compared with oncologists results in increased preventive care services, higher patient satisfaction, and reduced costs, without compromising cancer-specific outcomes.
• A survey of 1412 women diagnosed with early-stage breast cancer in 2014-2015 from Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries, achieved a 60% response rate.
• Participants were surveyed during initial treatment and approximately 6 years later in survivorship (2021-2022), with researchers oversampling Black, Asian, and Latina women to ensure diverse representation.
• Analysis focused on provider-led survivorship care delivery (oncology, shared care, PCP) and PCP management of eight common survivorship issues, with scores ranging from 0 to 32.

TAKEAWAY:

• Oncologist-led survivorship care remained predominant at 57.2%, while shared care accounted for 20.5% and PCP-led care for 22.4% of cases beyond 5 years posttreatment.
• PCP management of survivorship issues showed moderate engagement (mean score, 11.4; 95% CI, 11.0-11.8), with highest involvement in medication management (50.1%), physical activity improvement (49.1%), and chronic disease management (43.6%).
• Greater confidence in PCP’s ability to manage survivorship care was associated with increased PCP-led delivery (P = .01) and more PCP management of survivorship issues (P

IN PRACTICE:

“In this diverse cohort of breast cancer survivors, primary care involvement in survivorship care delivery and management of common survivorship issues remains low even more than 5 years after completing treatment and little variation was seen across survivor sociodemographic or clinical characteristics. Confidence in PCP ability to manage survivorship care was found to be important and may represent an opportunity to foster transition to primary care-led survivorship care delivery,” wrote the authors of the study.

SOURCE:

The study was led by Archana Radhakrishnan, MD, MHS, Department of Internal Medicine and Rogel Cancer Center, University of Michigan in Ann Arbor, Michigan. It was published online on December 6 in JCO Oncology Practice.

LIMITATIONS:

According to the authors, while this cohort comprises a diverse sample of women who are cared for across different practice settings, the study was sampled from only two geographic areas of the United States, which may limit generalizability to other settings.

DISCLOSURES:

The study received support from the American Cancer Society Research Scholar Grant RSG-19-015-01 and the National Cancer Institute Grants P30CA046592 and P01CA163233 awarded to the University of Michigan. Radhakrishnan was supported by the National Institutes of Health (K08 CA245237) and had no conflicts of interest. One of the other authors disclosed receiving honoraria from Kaiser Permanente and serving in a consulting or advisory role for Gilead Sciences.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.