Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: There are over 430,000 head and neck cancer (HNC) survivors in the United States (US) who have substantial survivorship care needs, ranging from HNC surveillance to care of long-term and late effects of HNC and its treatment. The American Cancer Society Head and Neck Cancer Survivorship Care Guideline supports a primary care physician (PCP)-led model of survivorship care, yet it is unclear if PCPs and oncologists support this.
Methods: The study design is a cross-sectional analysis of PCPs and head and neck oncologists at an academic medical center. The survey adapted the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS), a National Cancer Institute (NCI) and American Cancer Society (ACS) initiative. We replaced breast- and colorectal cancer-specific constructs with HNC constructs, otherwise maintaining the survey structure and content throughout. The co-primary study outcomes were PCPs have the skills necessary to 1) provide follow-up care related to the effects of cancer or its treatment of HNC survivors, and 2) initiate appropriate screening or diagnostic work-up to detect recurrent cancer, for HNC survivors. The primary exposure was physician type: PCPs versus head and neck oncologists. The surveys were disseminated on a rolling basis, with two reminders every two weeks from 4/24-10/24. Physicians were compensated $200 for survey completion. Descriptive statistics were performed using STATA 15. Statistical significance was defined as p<0.05 and p-values were reported as two-sided.
Results: We randomly invited 84 PCPs and all 9 head and neck oncologists at an academic medical center to participate in the survey. A total of 21 PCPs (25%) and 9 oncologists (100%) completed the survey for a total survey response rate of 32%. Physician characteristics were: female sex: 53%; mean age: 48; non-Hispanic white race/ethnicity: 79%; mean years in your primary specialty: 16; receipt of some HNC survivorship care training: 37%; see 26-50 patients per typical week: 59%. The practice distribution of head and neck oncologists was: surgeon: 56%, radiation oncologist: 22%; medical oncologist: 22%. The practice distribution of PCPs was: general internal medicine: 57%; family medicine: 33%; geriatrics: 10%. Most PCPs and oncologists (77%) did not agree that PCPs have the skills necessary to provide follow-up care related to the effects of cancer or its treatment of HNC survivors (PCPs: 67%, oncologists: 100%, p=0.10). Many PCPs and oncologists (63%) did not agree that PCPs have the skills necessary to initiate appropriate screening or diagnostic work-up to detect recurrent cancer, for HNC survivors (PCPs: 52%, oncologists: 89%, p=0.07). The most preferred models of survivorship care were specialized survivorship clinics led by physicians (40%) followed by an oncologist-led model of care (33%).
Conclusion: In this sample of physicians at an academic medical center, most PCPs and head and neck oncologists do not agree that PCPs have the skills necessary to provide core components of HNC survivorship care. While national validation studies are needed, these data may inform future guideline recommendations.