Oncology and Primary Care Involvement in Breast Cancer Survivorship Care More Than 5 Years After Initial Treatment

Very little is known about primary care involvement in the care of cancer survivors beyond the initial 5 years post-treatment when transitioning to primary care is guideline-recommended for many survivors.

The ICanCare study is a longitudinal survey of women diagnosed with breast cancer in 2014-2015 identified in the Georgia and Los Angeles SEER registries. Women were surveyed during initial treatment and again approximately 6 years later in survivorship (2021-2022; n = 1,412, 60% response rate). Respondents were asked which provider led their survivorship care (oncology, shared care, primary care provider [PCP]) and PCP management of eight common survivorship issues (range, 0-32). Multivariable-adjusted associations of participant characteristics with survivorship care delivery and PCP management of survivorship issues were evaluated using logistic and linear regression models, respectively.

Over half of the women (57.2%) reported oncologist-led survivorship care delivery, 20.5% shared care, and 22.4% PCP-led. PCP management of survivorship issues was moderate (mean, 11.4, 95% CI, 11.0 to 11.8) and was highest (often/always discussed) for medication management (50.1%), improving physical activity (49.1%), and chronic disease management (43.6%). Greater confidence in PCP's ability to manage survivorship care (v no or little confidence) was associated with PCP-led delivery (P = .01) and more PCP management of survivorship issues (P < .0001).

In this diverse cohort of breast cancer survivors, primary care involvement in survivorship care delivery and management of common survivorship issues remains low even more than 5 years after completing treatment and little variation was seen across survivor sociodemographic or clinical characteristics. Confidence in PCP ability to manage survivorship care was found to be important and may represent an opportunity to foster transition to primary care-led survivorship care delivery.