Bridging the gap between oncology and primary care for cancer patients has historically been a persistent challenge for patients and their providers. Experts from the Duke Cancer Institute and Duke Primary Care recently published an editorial for JCO Oncology Practice advocating for the development of onco-primary care models.
Together, Kevin Oeffinger, MD, and Cheyenne Corbett, PhD, lead the Center for Onco-Primary Care with the DCI. They, along with team members Leah Zullig, PhD, director of research for the Center for Onco-Primary Care, and Kevin Shah, MD, chief medical officer of Duke Primary Care, authored this editorial from their vantage points in leading onco-primary care initiatives at Duke.
The editorial underscores that effective methods for engaging primary care providers (PCPs) in care for cancer survivors are lacking. This is because it is common that PCPs have not received adequate information on these patients’ cancer treatments, risks, and the role of survivorship.
The concept of onco-primary care differs from traditional survivorship methods by focusing on a shared responsibility for patient care between oncologists and PCPs.
“Cancer survivorship care is focused on healthcare provided to people who have been diagnosed and are living with cancer, including a wide array of clinical services,” Zullig said. “Onco-primary care specifically focuses on the primary health care needs of the individual, which often includes factors like managing heart health and comorbid conditions, managing weight, taking non-cancer related medications as prescribed, and other salient health topics.”
The editorial also reflects on an article out of the Wake Forest School of Medicine about cancer survivor engagement in primary care. Using electronic health records, that study followed more than 5,000 patients with breast, colorectal, and uterine cancer for five-to-seven years post-diagnosis, after which most would not experience a recurrence. Only 43 percent of these patients reported sustained engagement with a PCP, defined as at least one annual visit. Survivors with early-stage disease were more likely to have PCP engagement, while those with advanced cancers were less likely.
“There seems to be a missed opportunity for patients with advanced cancers to follow up with their PCP” Oeffinger said. “By primarily following up with an oncologist and not a PCP, these patients could be undertreated for chronic conditions that may lead to worse overall health outcomes.”
While many comprehensive cancer centers offer survivorship services, that footprint is small in the context of the larger medical system. Therefore, new models to strengthen relationships with PCP networks could help survivors transition their care in survivorship, as well as increase quality of co-morbidity management during treatment. The DCI Center for Onco-Primary Care is an example of what this type of partnership could look like for other cancer centers.
“The Center for Onco-Primary Care is a first of its kind in the U.S. and internationally,” Oeffinger said. “We have developed numerous efforts to improve patient care across the cancer continuum, with daily engagement from our primary care providers and oncology teams”.
