Cancer Survivors Need Primary Care–Oncologist Partnership

A 57-year-old patient comes to your office to establish care. He has been treated for his stage III colon cancer with surgical resection and adjuvant chemotherapy and had no evidence of recurrence for the past 7 years. He has no other major medical conditions except for mild hyperlipidemia that is controlled with diet and exercise. What are the appropriate health promotion and disease prevention measures to recommend for this patient?

There are more than 13 million cancer survivors in the United States today. This number is expected to reach 18 million by 2022.¹ Cancer survivors are at increased risk for long-term morbidity and premature mortality, related directly to the cancer itself or to preexisting comorbidities, and to exposure to cancer therapy. As more patients with cancer return to their primary care physicians, there is a growing need for greater coordination of care and increased attention to health promotion and disease prevention in survivors.

The American Society of Clinical Oncology (ASCO) has just released its statement titledAchieving High-Quality Cancer Survivorship Care.² The statement highlights the lack of high-quality evidence to inform recommendations for follow-up care. Currently, there are no standardized practice guidelines for early detection of long-term complications and ongoing health promotion. The ASCO statement encourages adherence to relevant guidelines for the general population that address bone health monitoring, osteoporosis prevention, exercise and diet, smoking cessation and tobacco control, and sexual and reproductive health.² In the absence of specific recommendations pertaining to adult cancer survivors, the patient mentioned above would be subject to age-appropriate health maintenance guidelines.

The statement also highlights the consensus that both primary care and oncology providers are important to the long-term health of persons who have survived cancer.² Ideally, a shared-care model, using a risk-stratified approach, can take advantage of the expertise of the cancer team and the primary care physician in coordinating survivor follow-up. The Affordable Care Act includes provisions that focus on the delivery of high-quality coordinated care through ACOs, community health teams, and medical homes. This provision will hopefully increase collaboration between oncologists and primary care physicians in caring for adult cancer survivors.²

References:

1. Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220-241. (Full text)

2. McCabe MS, Bhatia S, Oeffinger KC, et al. American Society of Clinical Oncology Statement: Achieving High-Quality Cancer Survivorship Care. J Clin Oncol. 2013;31:631-640. (Full text)