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Forward Look

Routine Health Care for Cancer Survivors

Patients are sometimes unsure when to see their primary care provider. By Dara Chadwick

Routine health care often means seeing a primary care doctor for annual checkups, medical tests, immunizations and occasional sick visits. But after a cancer diagnosis, a person’s health care team widens to include oncologists, leaving some cancer survivors unsure of which provider to see for care not directly related to their cancer.

Which Doctor to See?
A survivorship care plan can help you determine whether to go to an oncologist or a primary care physician.
A patient’s preference for which doctor to see often depends on where that person is in cancer survivorship, says Lauren Wallner, an epidemiologist at the University of Michigan in Ann Arbor. Wallner led a study, published in the Sept. 1, 2017, Journal of Clinical Oncology, that found 21 percent of women who had been treated recently for ductal carcinoma in situ (DCIS) or stage I or II breast cancer preferred to see their oncologist for general preventive care, such as vaccinations or checkups, which is normally provided by a primary care doctor.

​Photo © iStock / monkeybusinessimages ​
Some cancer survivors form a bond with their oncologist during active cancer treatment that makes it challenging for them to transition to a primary care doctor for ongoing health care, says Shawna Hudson, a medical sociologist at Rutgers University Robert Wood Johnson Medical School in New Brunswick, New Jersey. Cancer survivors may also have “knowledge gaps” about appropriate follow-up care and the timing of that care, she says.

Doctors, too, may struggle with who should provide different types of care to cancer survivors. “There’s still a lot of role confusion” among providers, says Hudson, who co-authored a study on cancer survivorship care in primary care practices, published Sept. 25, 2017, in JAMA Internal Medicine. The study, which involved interviews at 12 U.S. primary care practices, found that primary care clinicians often felt they had lost touch with their patients as they “disappeared into oncology.”

Deborah Mayer, an oncology nurse and director of cancer survivorship at the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, says she’s found that a shared care approach, in which patients regularly see both an oncologist and a primary care doctor, often benefits patients. A primary care doctor may know the patient better and can help manage other medical conditions the person may have, she says.

Mayer says this approach works best when patients receive a survivorship care plan from their oncologist that provides guidelines on which doctor to see when and for what conditions. (See “Which Doctor to See?.)

Many primary care doctors today are engaged and involved with patients during cancer treatment, says Wallner. “I hear from a lot of primary care physicians that they wish they were [even] more involved,” she says.



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