To identify supporting evidence for this report, we searched the PubMed database. Terms used to find articles for analysis in the searches were “primary care and cancer survivorship”, “general practitioner and cancer survivorship”, “family practice and cancer survivorship”, and “care model and cancer survivorship”. The search was done in July, 2016. We used Endnote X7 reference software to search and manage references and the article database. There were no publication date restrictions in our
SeriesIntegrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities
Introduction
In 2005, the Institute of Medicine report: From cancer patient to cancer survivor: lost in transition was released. In addition to recommending coordinated and comprehensive care for cancer survivors, the report emphasised the importance of the involvement of primary care in the post-treatment follow-up of cancer survivors.1 Historically, the role of primary care providers (PCPs) across the cancer care continuum has mainly focused on prevention and early detection of the disease.2 An estimated 15·5 million cancer survivors live in the USA, most of whom have lived 5 years or more after active treatment and nearly half of whom are aged 70 years or older (panel 1).3, 4, 5 As this population continues to grow, strategies to integrate primary care into long-term care also need to evolve.
Ongoing and emerging trends in health care further increase the need for more extensive primary care integration into cancer survivorship care. These trends include: growing demands for acute cancer care provision from oncologists as more new primary diagnoses emerge in an ageing population;6 increasing numbers of long-term cancer survivors older than 70 years of age, many of whom need follow-up care and management of late and long-term effects due to cancer or its treatment;3, 4 a rising prevalence of comorbidities in both newly diagnosed patients and the surviving population, requiring shared management;7, 8 an increasing emphasis on behaviours needed for survivors to engage in self-management and lifestyle changes to optimise health;9 and changing reimbursement systems for medical care, specifically in the USA.10
Much of the literature published so far has focused on assessing the capacity of PCPs to care for the growing population of cancer survivors,11, 12, 13, 14, 15, 16 and the evidence suggests that PCPs' knowledge of cancer survivorship care is suboptimal.17, 18, 19 Although many PCPs prefer to continue care for survivors following cancer treatment,20 they consistently report the need for more training in cancer survivorship.21, 22 Oeffinger and McCabe23 proposed a shared-care model that described the need for risk stratification strategies to differentiate between cancer survivors who should be transitioned into oncology-based, primary care-based, or shared-care long-term care models. Such risk stratification approaches have been endorsed as essential for high-quality follow-up care;24 however, little evidence exists for the effectiveness of the models that might best suit specific subsets of cancer survivors (eg, high-risk, moderate-risk, or low-risk subsets).25 Systematic reviews26, 27 concluded that no standard of care exists in models of cancer survivorship care, and that such models vary widely according to the type of provider (physician or nurse) leading the care, whether a survivorship care plan is a key intervention feature of the model, and whether the model includes group or individual counselling.26, 28 These reviews26, 27 also found little evidence regarding the potential benefits of the models and their effects on outcomes.
In this Series paper, we review cancer survivorship models that have been described in the literature, specifically focusing on those aiming to integrate PCPs into the care of cancer survivors in different settings. On the basis of our findings, we offer insights for future opportunities in education, clinical practice, research, and policy initiatives that might enhance the role of PCPs in cancer survivorship care.
Section snippets
Overview of models of care
We used scoping review methods,29, 30 which include both narrative review, and an evidence mapping approach that is appropriate for use when a specialty is nascent, not yet well defined, and has insufficient evidence to support a systematic review. We identified previously described models of cancer survivorship care that specifically addressed the role of PCPs. On the basis of this literature, we outlined specific strategies that would actively engage PCPs in cancer survivorship care.
A total
Education and training
Because the number of cancer survivors continues to grow and most will receive their care in community-based settings, all PCPs should have the basic core competencies, including an understanding about the epidemiology of cancer survivorship, surveillance for cancer recurrences, screening and management of the long-term and late effects of cancer, the psychosocial concerns of cancer survivors, and health promotion (panel 2).44, 45 Such competencies are akin to others that PCPs should possess to
Conclusions
In summary, we found that although different models to involve primary care in cancer survivorship care do exist, few have been fully described or tested. One model will probably not fit all cases. Oncogeneralists could serve as experts in the care of cancer survivors in cancer centres, academic medical centres, or the community. In addition to providing clinical care, oncogeneralists might be vehicles for education of peers and oncologists. However, PCPs with no advanced training might be
Search strategy and selection criteria
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