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Haggstrom DA, Yeazel M, Clauser S, Arora N, Finstad D, Phalen S, Jackson G, van Ryn M. Who prescribes medications for symptom management and what is the impact of survivorship care plans among colorectal cancer survivors in the VA? Paper presented at: Cancer and Primary Care Research International Network Annual Meeting; 2012 Jun 6; Cleveland, OH.
Introduction: A shared-care model of follow-up involving tools to integrate both specialist and primary care physicians (PCPs) has been widely discussed in cancer survivorship. The important perceived role of PCPs in symptom management has been reported, but there is little data about who prescribes symptom treatment among cancer survivors. Methods: Veteran patients with a diagnosis of colorectal cancer in 2008 completed a mail survey (67% response rate). We included 825 Veteran cancer survivors who received surgery 6 months to 3 years prior to receiving the survey. Results: For cancer pain management, 41% of survivors reported receiving pain medications from PCPs, 26% from oncologists, 29% from surgeons, and 4% from gastroenterologists (GI). For bowel movements and nausea related to cancer, 36% and 24% of survivors, respectively, reported receiving medications from PCPs; 36% and 57% from oncologists; 19% and 15% from surgeons, and 8% and 5% from GI. For depression and sexual function issues related to cancer, 77% and 80%, respectively, received medications from PCPs; 18% and 11%, oncologists; 4% and 5%, surgeons; and 2% and 5%, gastroenterologists. A minority of veterans reported receiving a cancer treatment summary (36%) and survivorship care plan (34%). Survivors who received treatment summaries were more likely to report their providers were always "familiar with your most recent medical history" (71% vs. 57%), and survivors who received care plans were more likely report knowing "who was in charge of your care for all of your health problems" (83 vs. 69%). Conclusion: PCPs prescribe cancer-related medications for the greatest proportion of survivors and symptoms overall, and thus, de facto shared care models already exist in the VA. The question is not whether to pursue shared care among cancer survivors, but how to most effectively coordinate the care being delivered by PCPs and specialists. Treatment summaries may be effective in communicating medical histories, and care plans may be effective in assigning accountability. More work is needed to improve access to treatment summaries and care plans among Veterans diagnosed with colorectal cancer.
