Balasubramanian Bijal A, Jetelina Katelyn K, Bowen Michael, Santini Noel O, Lee Simon Craddock
UTHealth School of Public Health in Dallas, Dallas, TX.
Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
Int J Care Coord. 2018 Jun;21(1-2):26-35. doi: 10.1177/2053434518764634. Epub 2018 Jun 1.
Guideline-recommended surveillance reduces likelihood of colorectal cancer (CRC) recurrence, yet surveillance rates are low in the United States (US). Little is known about CRC surveillance rates among patients without health insurance and their primary care clinicians/oncologists' attitudes towards surveillance care.
A retrospective study of 205 patients diagnosed with Stage I-III CRC from 2008-2010 was conducted in an integrated system with a network of providers delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records and logistic regression models examined correlates of guideline-concordant surveillance. 41 Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding CRC surveillance.
38% of CRC patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (OR=0.35; 95 CI: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. 77% of oncologists responded that PCPs evaluated patients for cancer recurrence while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. 67% of oncologists said they rarely provide a treatment and surveillance care plan to survivors and over half said that they infrequently communicate with patients' other physicians about who will follow patients for their cancer and other medical issues.
Care coordination between PCP and oncologist is needed to improve CRC surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve CRC survivorship care.
指南推荐的监测可降低结直肠癌（CRC）复发的可能性，但美国的监测率较低。对于没有医疗保险的患者的CRC监测率以及他们的初级保健临床医生/肿瘤学家对监测护理的态度知之甚少。
对2008年至2010年诊断为I - III期CRC的205例患者进行了一项回顾性研究，该研究在一个综合系统中进行，该系统有一个为缺乏医疗保险的患者提供护理的提供者网络。从病历中描述监测模式，并通过逻辑回归模型检查符合指南的监测的相关因素。41名帕克兰初级保健医生（PCP）和24名肿瘤学家完成了调查，以评估他们对CRC监测的态度和做法。
38%的CRC患者接受了符合指南的监测；早期癌症患者接受监测的可能性较小（OR = 0.35；95%置信区间：0.14，0.87）。PCP和肿瘤学家在谁负责癌症监测护理方面存在明显差异。77%的肿瘤学家回答说PCP评估患者的癌症复发情况，而76%的PCP回答说这些服务要么是由肿瘤学家订购的，要么是与PCP共享的。67%的肿瘤学家表示他们很少为幸存者提供治疗和监测护理计划，超过一半的人表示他们很少与患者的其他医生就谁将跟踪患者的癌症和其他医疗问题进行沟通。
需要PCP和肿瘤学家之间的护理协调来改善CRC监测。需要新的共享护理模式来明确界定肿瘤学家和PCP的角色以改善CRC生存护理。
