Better Transition From Oncology to Primary Care Required to Address Long-term Side Effects of Chemotherapy

Many primary care physicians (PCPs) are unaware of the long-term side effects of 4 commonly used chemotherapy drugs for breast and colorectal cancer, according to results of the large Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS). Oncologists were much more likely to be aware of the late effects of all 4 drugs, but the survey suggested that there is still room for improvement in educating oncologists about late effects of cyclophosphamide, 1 of the 4 drugs included in the study.

With nearly 12 million cancer survivors in the United States who transition from the oncologist’s office to primary care settings, knowledge about late effects of treatment is a growing area of importance to optimize survivorship care, explained lead author Larissa Nekhlyudov, MD, assistant professor at Harvard Medical School and internist at Harvard Vanguard Medical Associates in Boston, Massachusetts.

“While we strongly encourage patients to be aware of the chemotherapy drugs they receive and their side effects, it is vitally important that oncologists relay this information to patients’ primary care providers so their risks can be appropriately managed throughout their lives,” she stated.

SPARCCS surveyed 1072 PCPs and 1130 oncologists by mail in 2009. Doctors were asked to identify which of 5 late effects of doxorubicin, paclitaxel, oxaliplatin, and cyclophosphamide were most common in their practices or mentioned in the literature.

While 95% of oncologists correctly identified cardiac dysfunction as a late effect of doxorubicin, only 55% of PCPs were able to do so. Peripheral neuropathy was correctly identified as being a late effect of oxaliplatin and paclitaxel by approximately 97% of oncologists, whereas only 22% of PCPs correctly cited this late effect for both drugs. The findings were even more worrisome for 2 late effects of cyclophosphamide, with premature menopause and second cancers being correctly identified by 72% and 62% of oncologists, respectively, versus only 15% and 17% of PCPs, respectively.

Finally, only 6% of PCPs were able to correctly identify late side effects of all 4 drugs compared with 65% of oncologists. In an adjusted analysis, being board certified in oncology and spending more time on patient care were strongly associated with the likelihood of correctly identifying late effects of these drugs.

“These findings should give us pause. Patients need summaries of the care and guidelines for survivorship to bring with them to primary care. This study makes a good case for electronic medical records. We need to educate primary care physicians and make sure the ball does not get dropped [during the transition to primary care],” stated ASCO President Michael Link, MD.

Reference

Nekhlyudov L, Aziz N, Lerro CC, Virgo KS. Oncologists’ and primary care providers’ awareness of late effects of cancer treatment: implications for survivorship care. Presented at: 2012 Annual Meeting of the American Society of Clinical Oncology; June 2012; Chicago, IL. Abstract 6008.