How are cared surviving cancer patients? Results of an Italian national survey to medical oncologists (MO) about clinical and organizational features of follow-up (FU).

Abstract

e19592 Background: The growing demand and the resources shortage are pushing toward more efficient models of survivorship care delivery. The interface between the MO, the specialists involved in FU and Primary Care Physicians (PCP) should be optimized. While the “oncology centered” model seems hardly sustainable, a “sequential” model (PCP FU after an arbitrarily defined period of specialist FU) is gaining acceptance. A proposed alternative is a “shared-cares” model that promotes the interaction between MO and PCP throughout the whole clinical history. AIOM established a working group with the aim of promoting improvements at the national level. A survey aimed at assessing attitudes and feelings of MO was considered preliminary to any further initiative. Methods: A 25-item questionnaire was sent to the mailing list of the Society, in a 2-months period during 2011. One MO per institution was asked to answer to the questions. The sections of the survey were the following: 1) organizational features of FU; 2) clinical features involving breast (BC) and colorectal cancer (CRC) FU; 3) feelings of MO about the different meanings of FU. Results: 91 MO of 160 institutions (57%) answered. A shared organization between specialists is reported in 71% for BC and 53% for CRC. However, a shared medical record is used in only 19% and 11% respectively. The ordinary communication between MO and PCP consists in the medical report released to the pt in 87% and in other instruments in 8%. 55% and 30% of the MO follow BC and CRC pts indefinitely. In case of discharge, a conclusive letter is sent to the PCP in 74%, while a survivorship care plan is delivered in only 9%. Only 6% and 14% of the MO feel that FU has an important role in reducing mortality or in improving recurrence detection in BC. These figures grow to 31% and 47% for CRC. The educational role of FU is considered important in 36% and 32% while the psychological role in 44% and 37% for BC and CRC respectively. Conclusions: Although efforts are made to include other specialists and PCP into survivorship care, MO tend to privilege the “oncology centered” model. National efforts are being encouraged to promote the diffusion of a “shared-cares” model.