Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Cancer. 2019 Dec 1;125(23):4319-4328. doi: 10.1002/cncr.32410. Epub 2019 Aug 26.
Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear.
This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists.
Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P < .001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system.
Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.
与一般人群相比，癌症幸存者面临更高的心血管事件风险。采用健康的生活方式可能会降低这些风险，并且指南鼓励为癌症幸存者提供健康促进咨询，但医生的遵医嘱程度尚不清楚。
这项混合方法研究调查了 91 名医生，包括 30 名初级保健医生（PCP）、30 名肿瘤学家和 31 名专家（泌尿科医生、皮肤科医生和妇科医生）。还对 12 名肿瘤学家进行了访谈。
大多数 PCP（90%）报告说至少向一些癌症幸存者推荐了健康促进（例如，减肥、戒烟），而很少有肿瘤学家（26.7%）和专家（9.7%）表示他们曾经这样做过（P<.001）。尽管大多数医生认为至少有 50%的癌症幸存者会遵守预防癌症复发的药物治疗方案，但他们也认为，如果患者试图减肥，他们不会继续遵守药物治疗方案。在访谈中，肿瘤学家表示担心提供健康促进建议会使患者感到痛苦或不知所措。通过主题分析确定的其他健康促进障碍包括：将癌症视为肿瘤学家关注的焦点、时间压力、行为改变培训不足以及医疗协调挑战。促进因素包括认为患者受益和将健康促进资源纳入癌症护理系统。
医生通常没有时间、专业知识或资源来解决癌症幸存者的健康促进问题。需要研究是否健康促进工作会影响药物治疗方案的遵守，因为医生的反应表明了这一点。
