ASCO 2012: Need for Improvement in Care of Survivors

A new analysis of data from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) reveals that many primary care providers (PCPs) are not familiar with the long-term side effects of the four chemotherapy drugs most widely used to treat breast and colorectal cancers: doxorubicin (Adriamycin), paclitaxel (Taxol), oxaliplatin (Eloxatin), and cyclophosphamide (Cytoxan). Although most oncologists surveyed were able to correctly identify the same late effects, the findings suggest a need for improvement.

The results highlight the need for better communication among oncologists, cancer survivors, and PCPs to improve the continuity of care after patients have completed treatment, and to monitor survivors for the late effects, said lead author Larissa Nekhlyudov, MD, MPH, assistant professor of population medicine at Harvard Medical School and a practicing internist. She noted that the number of cancer survivors in the US has risen dramatically from 3 million in the 1970s to nearly 12 million today. Once active cancer treatment ends, survivors are eventually seen more commonly in primary care settings for follow-up care.

Prior results from the survey revealed that many PCPs feel they lack the general knowledge and confidence to care for people who have been treated for cancer. The new analysis specifically examines knowledge of the most common late effects of treatment, including heart function problems, nerve problems, premature menopause, and second cancers.

Researchers found that among 1,072 PCPs surveyed, 55 percent of respondents identified cardiac dysfunction as a late effect of doxorubicin, 27 percent recognized peripheral neuropathy as being associated with paclitaxel, and 22 percent noted peripheral neuropathy as a late effect of oxaliplatin. For cyclophosphamide, the risk of premature menopause and second cancers was identified by 15 percent and 17 percent of PCPs, respectively.

Among the 1,130 oncologists surveyed, knowledge of the late effects ranged from 62 percent to 97 percent for the four drugs. Almost all oncologists (95 percent) identified cardiac dysfunction as a late effect of adriamycin, and peripheral neuropathy as a late effect of both taxol (97 percent) and oxaliplatin (97 percent). Oncologists did not do as well in identifying premature menopause (71 percent) and secondary malignancies (62 percent) as late effects of cytoxan.

Dr. Nekhlyudov said:

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. At the same time, our findings underscore the need for ongoing education among all physicians who care for cancer survivors, including oncologists, about the potential late effects of treatment.

Other survivor care topics at ASCO
Survivor care was also the theme of a poster discussion session at ASCO that included presentations on well-designed studies that found benefit for the use of yoga to alleviate musculoskeletal symptoms in breast cancer patients receiving aromatase inhibitors (Abstract 9028), and expressive writing for patients with renal cell carcinoma (Abstract 9029). The authors of the latter study concluded that expressive writing "enabled patients to manage and understand the trauma," thus making the cancer experience "less traumatizing, stressful, and defeating."

Another presentation was titled, "Patient information desire in actual decision making for advanced cancer treatment: Do doctors know their patients?" (Abstract 9036). My favorite title was "Women know, and men wish they knew, prognostic information in advanced cancer." (Abstract 9037).