What to Do About Long-term Follow-up Care Among Cancer Survivors

As new cancer therapies have prolonged life, an interesting question has arisen among community oncologists: “Is it better to transfer long-term cancer survivors to general practitioners or develop clinics for long-term survivors within cancer centers?”

That’s the question submitted to the Journal of Clinical Oncology by authors Umberto Tirelli, Michele Spina, Accursio F. Augello, and colleagues from the National Cancer Institute of Aviano in Italy. They were responding to a study by Virgo KS, et al, that reviewed barriers to breast and colorectal cancer survivorship care, as perceived by primary care physicians (PCPs) and medical oncologists (MOs).

So who takes care of the survivors?

According to the study by Virgo and colleagues, it wasn’t long ago that post-treatment survival among cancer patients was relatively short. Surveillance used to focus on detecting recurrences and new primary cancers. The study highlights challenges that arise when transitioning survivors’ care from medical oncologists to primary care physicians.

Virgo and colleagues recommend that high priority should be given to “developing more efficient methods of communication among providers and between providers and patients, designing new models of survivorship care such as oncology medical homes, and establishing educational programs tailored to the specific concerns of PCPs regarding appropriate surveillance testing and late- and long-term effects of cancer and its treatment.”

Tirelli and colleagues respond that developing cancer survivorship programs and clinics in cancer hospitals that are staffed by both medical oncologists and psychologists would be a viable option. They note that patients with cancer are reluctant to abandon their oncologist after what is often a long and arduous treatment regimen. They add that other medical specialists, notably cardiologists, would also be accessible in a hospital setting.

“In fact, it should not be forgotten that cardiovascular adverse effects are becoming increasingly important in long-term care of cancer survivors, in particular patients with breast cancer and lymphoma that may have received anthracyclines and/or radiotherapy. In our cancer center, the cancer clinic for long-term survivors is active with combined work of medical oncologist/hematologist and psychologist,” they write.

Could this care be delivered in a community oncologist office setting? That remains to be seen, and it will certainly be a topic in future oncology business management Web postings.