Who provides psychosocial follow-up care for post-treatment cancer survivors? A survey of medical oncologists and primary care physicians

Abstract

Purpose: Addressing psychosocial needs, including key components of psychologic distress, physical symptoms, and health promotion, is vital to cancer follow-up care. Yet little is known about who provides psychosocial care. This study examined physician-reported practices regarding care of post-treatment cancer survivors. We sought to characterize physicians who reported broad involvement in (ie, across key components of care) and shared responsibility for psychosocial care.

Methods: A nationally representative sample of medical oncologists (n = 1,130) and primary care physicians (PCPs; n = 1,021) were surveyed regarding follow-up care of breast and colon cancer survivors.

Results: Approximately half of oncologists and PCPs (52%) reported broad involvement in psychosocial care. Oncologist and PCP confidence, beliefs about who is able to provide psychosocial support, and preferences for shared responsibility for care predicted broad involvement. However, oncologists' and PCPs' perceptions of who provides specific aspects of psychosocial care differed (P < .001); both groups saw themselves as the main providers. Oncologists' confidence, PCPs' beliefs about who is able to provide psychosocial support, and oncologist and PCP preference for models other than shared care were inversely associated with a shared approach to care.

Conclusion: Findings that some providers are not broadly involved in psychosocial care and that oncologists and PCPs differ in their beliefs regarding who provides specific aspects of care underscore the need for better care coordination, informed by the respective skills and desires of physicians, to ensure needs are met. Interventions targeting physician confidence, beliefs about who is able to provide psychosocial support, and preferred models for survivorship care may improve psychosocial care delivery.

Fig 1.

Physician-reported practices for delivery of psychosocial follow care. Percentages do not always sum to 100 within oncologists (ONCs) and primary care physicians (PCPs) because of missing data. For treatment of sexual dysfunction, 18.6% of oncologists said they were not involved, such that 14.2% of oncologists reported “another specialist orders or provides this care” and 4.2% reported “I am not involved in this care.” There were significant differences by physician group in reported provision of care for all seven items assessed (P < .001): assessment of adverse psychologic events: χ² = 22.2; treatment of anxiety or depression: χ² = 72.0; counseling on diet and physical activity: χ² = 14.0; counseling on smoking cessation: χ² = 48.1; treatment of pain related to cancer or its treatment: χ² = 227.4; treatment of fatigue: χ² = 6.3; treatment of sexual dysfunction: χ² = 120.7.