Nearly 50% of cancer survivors experience psychosocial and physical late effects of cancer treatment, and these side effects can be severe, debilitating, and sometimes permanent. In addition to follow-up by specialists, 75% of cancer survivors also visit their PCP during and after treatments. But the evidence suggests that PCPs' knowledge of cancer survivorship care is suboptimal, and PCPs themselves consistently report the need for more training in cancer survivorship. By 2025, the demand for oncology services is anticipated to outweigh the number of cancer specialists available. "We know that the oncology workforce can't assume all of the responsibility of cancer survivorship care. Therefore, it's imperative to integrate PCPs into cancer survivors' follow-up care," said Dr Chaput, Head of the McGill University Health Centre Cancer Survivorship Program in Montreal, Canada.
Workshop Improves Knowledge, Confidence
She and her colleagues delivered a 60-minute accredited introductory workshop on cancer survivorship to a group of 167 PCPs at 6 sites in Montreal. It focused on common survivorship issues and was based on recommended guidelines by recognized entities.
The same physician presented each workshop, and 109 participants voluntarily completed surveys before and after the workshop that measured satisfaction, knowledge, and behavior (intent to change practice). "It's one thing to teach them, but we want to know if they're going to apply it to practice," she noted.Ninety-five percent of respondents agreed that the workshop content was relevant and useful, and 99% expressed the intent to incorporate the survivorship information they learned into their practice. Before the workshop, only 11% of participants were able to identify 2 standards of care for survivorship, but postsurvey results showed a statistically significant increase in knowledge, with 63% of respondents able to name 2 standards. A significant increase was also seen in participants' knowledge of common late effects of cancer treatment such as cognitive dysfunction. "Participants were able to much more precisely identify issues associated with survivorship care after the workshop," said Dr Chaput. "Their answers were much less vague, which was very pleasing to see."
At 3 months after the workshop, confidence remained significantly higher than preintervention levels for both knowledge of "adverse physical effects" and "adverse psychosocial outcomes" of cancer and its treatments.According to Dr Chaput, much of the research so far has focused on determining PCP barriers to survivorship care—such as limited topic proficiency and issues with coordination of care—but more efforts should focus on actually optimizing PCPs' survivorship knowledge. "This would improve patient care, but would also reassure the oncology workforce who are concerned about transitioning low-risk patients," she said.
She also stressed the ongoing need for optimization of evidence-based follow-up recommendations, adding, "it would be nice to see more evidence from randomized controlled trials in order to solidify the care we give to patients."