Primary Care Physicians Hold Significant Value in Oncology Care

Oncologists were tasked with considering the collaborative role of a frontline physician—at least for the duration of a session held at the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting in Chicago, IL, this week.

In a discussion led by panelists Larissa Nekhlyudov, MD, MPH; Piyush Srivastava, MD, gastrointestinal medical oncologist at Kaiser Permanente; Trevor Jolly, MBBS, medical oncologist at UNC Health Care; and Elizabeth Schiff, a patient advocate and two-time cancer survivor, experts opened discussion by questioning the lines of communication between a primary care physician (PCP) and oncologists.

Answers ranged from communication through electronic health record (EHR) systems to more direct phone calls. But though 1 thing remained consistent throughout every answer: specialists need to be doing better.

In a series of interactive case studies, the panel explained anecdotally how PCPs could become more involved in cancer care. The first case involved a 75-year-old post-menopausal female with newly diagnosed screen detected left-sided invasive breast cancer; her medical history included a body mass index of 31.4 and several years of hypertension. The audience and panelists were asked which medical condition was most likely to cause the patient’s death in the next 10 years.

Most answered cardiovascular disease, as one of the highest risk factors for cardiovascular disease is hypertension. However, when the audience was asked who they would prefer to manage the patient’s blood pressure and other cardiovascular disease risk factors, a cardiologist or a PCP, most preferred a PCP.

This surprised Nekhlyudov, who expected most audience members to recommend a cardiologist. She presented data from a study published in JAMA in February which found that PCPs “have a huge effect on mortality for cancer patients. Every 10 additional PCP per 100,000 population is associated with 51.5 extra days of life expectancy, versus 19.2 days for additional specialists. Also, every 10 additional PCPs per 100,000 population was associated with reduced cardiovascular, cancer, and respiratory mortality by 0.9% to 1.4%,” said Nekhlyudov.

Jolly couldn’t agree more regarding the importance of a primary care physician in a cancer patient’s journey. He explained that what he often sees in practices is that, as with the case study, the oncologist will let the PCP deal with the hypertension, and the oncologist will deal with the cancer.

“But we need to collaborate more,” he said. “If you see that your patient has hypertension, call her physician. Bring it to their attention. Ask them to follow up if you started her on a hypertension medication. That communication is key.”

Though the panelists and the audience seemed to be in agreement on this matter, 1 audience member brought up a point that had not yet been mentioned: the potentially burdensome economics of a specialty visit.

Schiff agreed. Having been through her own cancer journey, she explained that she knew the care coordination could get complicated.

“If you need to choose between seeing your oncologist and seeing your PCP, well, that would be hard. If you’re in active treatment, I would imagine you’d see your oncologist,” Schiff said. “But this is where the communication between the oncologist and the PCP is essential.”

If costs of care limited patients to only routine oncologist appointments, then it’s the responsibility of the oncologist to communicate with the PCP, Schiff said, and to ensure they’re kept up to date on the patient’s process of care.

When asked to describe ways to improve communication between PCPs and oncologists, the overarching responses included creating an integrated EHR system across the different providers and needing more time to meet with each patient.

A version of this article was originally published by The American Journal of Managed Care as “The Importance of Including Primary Care Physicians in a Patient's Cancer Journey.”

The session, “Bringing the Primary Care Physician Back Into Cancer Care,” was presented at ASCO 2019.