Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA.
J Gen Intern Med. 2019 Oct;34(10):2091-2097. doi: 10.1007/s11606-019-05189-y. Epub 2019 Jul 31.
Due to risk for treatment-related late effects and concerns about cancer recurrence, long-term cancer survivors have unique medical needs. Survivors' preferences for care may influence adherence and care utilization.
To describe survivors' preferences for care and factors associated with preferred and actual care.
Cross-sectional analysis of participants in a longitudinal study using mailed questionnaires.
Survivors of ten common cancers (n = 2,107, mean years from diagnosis 8.9).
(1) Survivors' preferences for primary care physician (PCP) and oncologist responsibilities across four types of care: cancer follow-up, cancer screening, preventive health, and comorbid conditions. (2) Survivor-reported visits to PCPs and oncologists.
The response rate was 42.1%. Most long-term survivors preferred PCPs and oncologists share care for cancer follow-up (63%) and subsequent screening (65%), while preferring PCP-led preventive health (77%) and comorbid condition (83%) care. Most survivors (88%) preferred oncologists involved in cancer follow-up care, but only 60% reported an oncologist visit in the previous 4 years, and 96% reported a PCP visit in the previous 4 years. In multivariable regressions, those with higher fear of cancer recurrence were less likely to prefer PCP-led cancer follow-up care (OR = 0.96, CI = 0.93-0.98), as did survivors with advanced cancer stage (OR = 0.56, CI = 0.39-0.79). Those with higher fear of recurrence (OR = 1.03, CI = 1.01-1.04) or who preferred oncologist-led cancer follow-up care (OR = 2.08, CI = 1.63-2.65) had greater odds of seeing an oncologist in the last 4 years.
Most cancer survivors preferred PCPs and oncologists share care for cancer follow-up and screening, yet many had not seen an oncologist recently. Survivors preferred PCP-led care for other preventive services and management of comorbid conditions. These findings highlight the important role PCPs could play in survivor care, suggesting the need for PCP-oriented education and health system policies that support high-quality PCP-led survivor care.
由于治疗相关的晚期效应风险和对癌症复发的担忧，长期癌症幸存者有独特的医疗需求。幸存者对护理的偏好可能会影响其依从性和护理的利用。
描述幸存者对护理的偏好，以及与偏好和实际护理相关的因素。
使用邮寄问卷对纵向研究的参与者进行的横断面分析。
十种常见癌症的幸存者（n=2107，诊断后平均年限为 8.9 年）。
（1）四种类型的护理：癌症随访、癌症筛查、预防保健和合并症，幸存者对初级保健医生（PCP）和肿瘤医生责任的偏好。（2）幸存者报告的 PCP 和肿瘤医生就诊次数。
回复率为 42.1%。大多数长期幸存者希望 PCP 和肿瘤医生共同负责癌症随访（63%）和后续筛查（65%），而更喜欢 PCP 主导的预防保健（77%）和合并症（83%）护理。大多数幸存者（88%）希望肿瘤医生参与癌症随访护理，但只有 60%报告在过去 4 年内看过肿瘤医生，96%报告在过去 4 年内看过 PCP。在多变量回归中，那些对癌症复发恐惧程度较高的人不太可能偏好 PCP 主导的癌症随访护理（OR=0.96，CI=0.93-0.98），癌症分期较晚的幸存者（OR=0.56，CI=0.39-0.79）也是如此。那些对复发恐惧程度较高的人（OR=1.03，CI=1.01-1.04）或偏好肿瘤医生主导的癌症随访护理的人（OR=2.08，CI=1.63-2.65），在过去 4 年内看肿瘤医生的可能性更大。
大多数癌症幸存者希望 PCP 和肿瘤医生共同负责癌症随访和筛查，但许多人最近没有看过肿瘤医生。幸存者更喜欢 PCP 主导的其他预防服务和合并症的管理。这些发现强调了 PCP 在幸存者护理中可以发挥的重要作用，表明需要针对 PCP 的教育和支持高质量 PCP 主导的幸存者护理的卫生系统政策。
