Recent Innovations in Primary Care Cancer Survivorship Care Delivery

Abstract

<h3>Context:</h3> The IOM, NCI and professional organizations have endorsed an active role for primary care in the care of individuals with a history of cancer. While primary care has not adopted this role widely, innovations in survivorship care delivery have emerged in recent years. <h3>Objective:</h3> To describe emerging forms of primary care survivorship care delivery. <h3>Study design and analysis:</h3> As part of a larger NCI-funded study, we used snowball sampling to recruit 11 clinician innovators in primary care survivorship care for qualitative depth interviews before reaching saturation. We performed analysis by listening to interview recordings, reading transcripts, writing case summaries, and comparing key characteristics and themes. We supplemented interviews with online information about participants and their settings. <h3>Setting:</h3> Primary care clinics or primary care survivorship clinics in cancer centers in the US. <h3>Population studied:</h3> Clinician innovators in primary care survivorship care. <h3>Intervention/Instrument:</h3> Depth interviews of primary care survivorship care delivery. <h3>Outcome measures:</h3> Description of survivorship care delivery and major themes. <h3>Results:</h3> We identified three forms of primary care survivorship care delivery: 1) integrating care for patients with a history of cancer within regular primary care panels; 2) “blocking” primary care clinic hours for patients with a history of cancer; and 3) delivering primary care within cancer centers. Innovators provided consultative or empaneled care. They described structural elements enabling these forms: connections to cancer centers and oncologists; having a system wide EHR; holding longer visits; and having informational and referral resources. Innovators described how providing consistent care to patients with a history of cancer enabled them to develop a “cancer lens” or algorithm; they felt other primary care clinicians needed to be aware of and ask questions about patient cancer history to gain more comfort providing survivorship care. <h3>Conclusions:</h3> Primary care innovators offer lessons for supporting the spread of primary care survivorship care. Primary care clinicians do not need to become survivorship specialists, but they need to be aware of the possible late effects of cancer and cancer treatments. Connecting to oncology and others with survivorship knowledge, referral networks, and information sources are essential to building primary care’s capacity and comfort in delivering survivorship care.