Sep 29, 2014
By Shira Klapper, Senior Writer/Editor
A study out of Israel assessed how patients with cancer perceive the role of their family physician (FP) during their treatment. The study found that while 96% of patients had a regular FP, and 76% of patients stated it was important to them to have their FP involved in their treatment while receiving cancer care, only 9% of patients said they would consult their FP in the case of an urgent problem; 72% stated they would turn first to the oncology clinic. Results from the study, “Involvement of the Family Physician in the Care of Chemotherapy-Treated Patients with Cancer: Patients’ Perspectives,” are reported in the September issue of the Journal of Oncology Practice (JOP). The study was funded by the Israeli Cancer Society.
In addition, in this Israeli cohort, one-third (30%) of patients stated that their oncologist communicated with the FP and one-third (32%) of patients thought their FP was trained to treat non-oncologic medical problems that are affected by cancer treatment. For example, corticosteroids may alter glucose levels, bevacizumab may induce hypertension, and cisplatin may cause chronic renal failure.
According to coauthor Ido Wolf, MD, patients' concerns about communication between the FP and oncologist are based in reality. In the Israeli health care system, all citizens must join an HMO where they receive primary care. However, while the medical data within HMOs are provided to all specialists, including oncologists, information from cancer centers is kept separate and is not available to the family physician.
|Ido Wolf, MD|
“There is one electronic medical record for the oncology centers and a different one for each of the HMOs,” said Dr. Wolf. “Not all data are available to the family physician.”
Older patients’ need for primary care
To gather the data for this study, 265 patients were asked to fill out questionnaires that included 19 statements about the role of the FP and oncologists during cancer treatment. Patients were asked to respond on a scale of one to five to statements such as, “Is the FP trained for Oncologic treatment?” and “Is the oncologist willing to treat non-Oncologic issues?”
These findings about the role of the FP during cancer care are especially important in light of a growing population of older cancer patients. For these patients, pre-existing chronic conditions such as diabetes and high blood pressure—and the medications they take for those conditions—might interact with the cancer and cancer treatments in ways that impact overall health.
“An older patient with metastatic breast or colon cancer who is getting chemo or a biological agent for several years likely has other issues like diabetes or hypertension for which they are taking drugs,” said Dr. Wolf. “The questions are—who’s responsible for managing those conditions, and who’s coordinating that care?”
According to Dr. Wolf, there is a growing need to manage primary care issues alongside cancer treatment because patients with cancer are now living longer.
“Not too many years ago, a patient with metastatic colon cancer had an average life expectancy of about six months,” said Dr. Wolf. “Now they could live for three years or more. And during that time, they not only have cancer, but other diseases and conditions.”
And, said Dr. Wolf, oncologists in Israel may not be trained in managing these comorbidities. “Unlike in the US, in Israel oncologists don't do a full residency in internal medicine. They do only nine months as part of the oncology training."
Training family physicians
Dr. Wolf is putting his hopes in initiatives that will train FP’s to understand more about the needs of patients with cancer.
“We don't have a formal oncology training or elective for FPs,” said Dr. Wolf. “So FPs need to be trained, not to know how to give chemotherapy, but how to deal with common problems, side effects, and the language of oncologists. This is something that is still missing, at least in Israel, and I think in other countries as well.”
Currently, teams of oncologists and FPs in Israel are working together on initiatives that will provide more oncology training in medical schools and foster better communication between oncologists and FPs.
“It’s very early, but hopefully we’ll get to that point one day,” said Dr. Wolf.
Ido Wolf, MD is the Head of the Medical Oncology Department in the Oncology Division at the Tel Aviv Sourasky Medical Center, Israel.
Ben-Ami E, Merom H, Sikron F, et al. Involvement of the family physician in the care of chemotherapy-treated patients with cancer: patients’ perspectives. J Oncol Pract. 2014;10:298-305.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO and JOP with additional perspective provided by the lead or corresponding author.
@ 2014 American Society of Clinical Oncology