Berkowitz Callie, Allen Deborah H, Tenhover Jennifer, Zullig Leah L, Ragsdale John, Fischer Jonathan E, Pollak Kathryn I, Koontz Bridget F
Duke University School of Medicine, Durham, NC, USA.
Duke Cancer Institute, Box 3085 DUMC, Durham, NC, 27710, USA.
J Cancer Educ. 2018 Dec;33(6):1323-1327. doi: 10.1007/s13187-017-1250-3.
Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.
头颈部癌症（HNC）幸存者的长期护理工作复杂，需要多个医疗服务提供者之间进行协调。临床实践指南强调了初级保健提供者（PCP）在筛查继发性癌症/复发、评估晚期/长期副作用以及转诊以进行适当的毒性专科管理方面的作用。然而，在初级保健实践范围内，这些职责可能难以履行。我们开展这项研究以探索初级保健提供者在HNC幸存者护理中的偏好、舒适度和知识水平。我们试运行了一项基于网络的40项调查问卷，该问卷由肿瘤学家和初级保健提供者共同参与设计，目标受众为家庭医学和内科提供者。在一所大学卫生系统内，历时2个月收集了回复。初级保健提供者（n = 28；回复率 = 11.3%）对了解癌症治疗后的健康促进措施很感兴趣（89%），并且普遍认为他们目前的执业模式涉及健康的生活方式行为（82%）。然而，只有32%的初级保健提供者觉得自己有信心处理化疗、放疗或手术的晚期/长期副作用。只有29%的人觉得自己有信心进行适当的癌症筛查。在与肿瘤学提供者分担护理职责方面，初级保健提供者认为在治疗后的第一年负责30%的护理工作，5年后负责81%的护理工作。71%的初级保健提供者同意肿瘤学家为他们提供了必要信息，但仍有32%的初级保健提供者发现与癌症医疗服务提供者进行协调很困难。虽然这些初级保健提供者意识到对长期幸存者的护理责任有所增加，但大多数人对筛查复发和处理晚期/长期副作用感到不自在。初级保健提供者和肿瘤学提供者之间的教育和相互协调可能会改善对幸存者的护理。
