National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
September 8, 2009 • Volume 6 / Number 17

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Guest Director's Update

Finding the Right Mix of Care Providers for Cancer Patients

Dr. Rachel Ballard-Barbash

Receiving a cancer diagnosis has never been more complex. Although surgery is still a mainstay of cancer treatment, the therapeutic options for many cancers include a growing array of targeted therapies, multiple choices for radiation therapy, and new chemotherapy drugs.

We also know more about the risks and benefits of different treatments, and how specific genetic mutations influence a patient’s response to different therapies, meaning we can individualize care to a far greater extent than has ever been possible. And our understanding of the issues that affect cancer survivors, and how to best address them, is improving every day.

When it comes to effective models of cancer care, however, we know far less. Whether treatment is received at a comprehensive cancer center or, as is the case for the majority of patients, at a community hospital, it’s unclear who is directing and coordinating the clinical care decisions for those undergoing active treatment. With the expected increase in cancer incidence (due in large part to an aging population), the health care community must begin to focus on this critically important issue.

A recent NCI-led study, conducted by the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium, represents one of the largest efforts to date to address at least one aspect of this issue. The study, which involved a survey of nearly 1,700 primary care physicians (PCPs) and more than 1,600 oncologists, provides one of the first robust assessments of the role that PCPs play for those receiving active care for lung and colorectal cancer.

The findings might surprise some. Most PCPs reported at least some involvement in cancer-related care decisions, and approximately one in five reported heavy involvement in cancer-related care, including choices about surgery and management of co-morbid conditions, pain, and depression. Certain factors, such as age and barriers to referral for more specialized cancer care, influenced the extent of PCP involvement. Nevertheless, the study documented the active role these clinicians play in managing and influencing the treatment of patients with cancer.

There is a complicated and much broader societal context around these findings, including an anticipated shortage of as many as 4,000 oncologists over the next 15 years and indications that PCPs may already be in short supply. These concerning trends make it all the more vital to thoroughly assess existing cancer care models and, ideally, identify better options where they exist.

Along those lines, CanCORS investigators will also look at whether PCPs’ active involvement makes a difference in the quality of care and patient outcomes. Such data can help to inform the extent to which PCPs can and should play a role in active cancer care and potentially generate leads for studying existing models of effective, coordinated care.

These studies can also provide the type of data needed for informed policymaking on issues such as training, measuring quality of care, and reimbursement.

With continuing progress in cancer prevention, early diagnosis, and personalized treatment, we will need parallel advances that ensure the appropriate and most effective delivery of care. They are intrinsically linked and essential to our goals of significantly reducing the cancer burden in the most effective and efficient manner possible.

Dr. Rachel Ballard-Barbash
Associate Director, Applied Research Program
NCI’s Division of Cancer Control and Population Sciences