Associations Among Cancer Survivorship Discussions, Patient and Physician Expectations, and Receipt of Follow-Up Care

Abstract

Purpose To explore the associations among cancer survivorship discussions, patient-physician expectations, and receipt of follow-up care in cancer survivors. Patients and Methods We surveyed cancer survivors about various aspects of their care, including expectations of their providers' roles, whether discussions with a physician had occurred, and self-reported patterns of follow-up. Primary care providers (PCPs) and oncologists were also surveyed for their own perceived roles. We developed a scoring system to evaluate the level of agreement in expectations between patients and physicians and between PCPs and oncologists (where 0 = most discordant and 4 = most concordant). Regression and stratified analyses were conducted to examine the relationships among expectations, discussions, and follow-up. Results In total, 535 patients (54%) and 378 physicians (62%) responded. Survivorship care expectations were most discrepant between PCPs and oncologists (mean score, 1.78), moderate between patients and oncologists (mean score, 1.97), and most similar between patients and PCPs (mean score, 2.82). Having a conversation specifically about cancer follow-up was associated with better concordance between patients and oncologists, but not for patients and their PCPs or between physicians. Better concordance in patient-oncologist expectations also correlated with greater odds of receiving certain aspects of follow-up care, such as influenza vaccinations and physical examinations, but only if a discussion about cancer follow-up had occurred. Conclusion A discussion about cancer follow-up may affect survivorship care through its primary influence on patient-oncologist expectations. Further work is required to clarify the aspects of survivorship discussions that are important for optimal cancer survivorship care planning.