More women are surviving breast cancer - and living longer - but the number of oncologists has remained steady, leaving a gap in care for many of the over 2.8 million breast cancer survivors in the United States. Health care systems are starting to transition patients to primary care providers (PCPs) for their survivorship care, but only 10 percent of PCPs working in low-income settings reported meeting the recommended guidelines for such care, according to a new study.
"Breast cancer survival rates have increased more than 30 percent in the past two decades with patients diagnosed today having a 90 percent chance of living at least five years," said lead author and Robert Wood Johnson Foundation Clinical Scholar Aaron Dawes, MD, a general surgery resident at the University of California, Los Angeles (UCLA). "Our specialty clinics in oncology and surgical oncology are primarily set up to treat patients for finite periods of time. With cancer patients living longer than ever, we need to start transitioning survivors to other types of providers."
The study is the first to explore the preparedness of those caring for cancer survivors in safety-net hospitals. The PCPs, who included physicians, nurses, and physician assistants, were assessed on their knowledge, attitudes, and confidence in providing care to breast cancer survivors, including transitioning care, surveillance, and management of emotional health.
While all reported training in survivorship care, only 1 in 4 felt confident in monitoring for a recurrence or handling patients' emotional distress and mental health. And just 14 percent reported feeling confident in detecting physical adverse effects of treatment. When asked whether they provided specific, routine treatment services outlined in national survivorship care plans, an overwhelming 90 percent did not meet recommended clinical guidelines.
"It is great news that more and more women are surviving breast cancer and living longer," said Dawes. "But it means we need to improve the readiness of primary care providers to deliver appropriate care for these patients. Fortunately, primary care providers appear eager and willing to care for breast cancer survivors; they just may need more training to do so effectively."
The study, which will appear in Cancer, was also supported by the Department of Veterans' Affairs.