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The Role of Primary Care Physicians in Cancer Care

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ABSTRACT

BACKGROUND

The demand for oncology services in the United States (US) is increasing, whereas a shortage of oncologists looms. There is the need for a better understanding of the involvement of primary care physicians (PCPs) in cancer care.

OBJECTIVE

To characterize the role of PCPs in cancer care, compare it with that of oncologists, and identify factors explaining greater PCP involvement in cancer care.

DESIGN

National survey of physicians caring for cancer patients conducted by the Cancer Care Outcomes Research and Surveillance Consortium.

PARTICIPANTS

1694 PCPs; 1621 oncologists.

MEASUREMENTS

Questionnaires mailed during 2005 and 2006 examined the participation of physicians in 12 aspects of care for cancer patients.

MAIN RESULTS

Over 90% of PCPs fulfilled general medical care roles for patients with cancer such as managing comorbid conditions, chronic pain, or depression; establishing do-not-resuscitate status; and referring patients to hospice. Oncologists were less involved in these roles. Determining the treatment preferences of individual patients and deciding on the use of surgery were the only cancer care roles in which ≥50% of PCPs participated. Twenty-two percent of PCPs reported no direct involvement in cancer care roles while 19% reported heavy involvement. PCPs who were aged ≥50 years, were internists or geriatricians, taught medical students, saw more cancer patients, or experienced referral barriers fulfilled more roles. Rural practice location was not associated with greater PCP involvement in cancer care.

CONCLUSIONS

PCPs across the US have an active role in cancer patient management. Determining the optimal interface between PCPs and oncologists in delivering and coordinating cancer care is an important area for future research.

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Acknowledgements

This study was supported by grants from the National Cancer Institute to the CanCORS Statistical Coordinating Center and Primary Data Collection and Research Centers: U01 CA093344, U01 CA093332, U01 CA093324, U01 CA093348, U01 CA093329, U01 CA01013, U01 CA093326, and by a grant from the Department of Veteran’s Affairs to the Durham VA Medical Center, U01 CDA093344 (MOU) and HARO 03-438MO-03.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4005; 6130 Executive Boulevard, Bethesda, MD, 20892-7344, USA

    Carrie N. Klabunde PhD, Anita Ambs MPH & Steven Clauser PhD

  2. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Nancy L. Keating MD, MPH

  3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Nancy L. Keating MD, MPH & Yulei He PhD

  4. Division of Clinical and Administrative Pharmacy, University of Iowa, Iowa City, IA, USA

    William R. Doucette PhD

  5. Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Diana Tisnado PhD & Katherine L. Kahn MD

  6. RAND Corporation, Santa Monica, CA, USA

    Katherine L. Kahn MD

Authors
  1. Carrie N. Klabunde PhD
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  2. Anita Ambs MPH
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  3. Nancy L. Keating MD, MPH
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  4. Yulei He PhD
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Corresponding author

Correspondence to Carrie N. Klabunde PhD.

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Klabunde, C.N., Ambs, A., Keating, N.L. et al. The Role of Primary Care Physicians in Cancer Care. J GEN INTERN MED 24, 1029–1036 (2009). https://doi.org/10.1007/s11606-009-1058-x

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  • DOI: https://doi.org/10.1007/s11606-009-1058-x

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