This study examines at a population level how colorectal cancer (CRC) survivors evaluate the continuity and quality of their follow-up care after treatment, particularly for those in the care of a primary care provider (PCP).
A survey was mailed in 2010 to all individuals in Manitoba, Canada diagnosed in 2008/2009 with stage II and III CRC. Respondents were asked to identify the main provider(s) of their follow-up care. Those indicating a PCP completed the Patient Continuity of Care Questionnaire (PCCQ), which assesses continuity of care upon discharge from hospital to community. Quality of life (QOL) on the Functional Assessment of Cancer Therapy—Colorectal (FACT-C) and the Illness Intrusiveness Rating Scale was collected as well as demographic information. Descriptive statistics and regression analyses were utilized.
The response rate was 246/360 or 68.3 %. Most participants were Caucasian with a mean age of 70 and 18 months from diagnosis. A single “main provider” of follow-up care was named by 47 %, most frequently a FP or oncologist, but a majority (53 %) indicated multiple providers. Twenty-four combinations of providers were described. The 106 respondents (43.1 %) who named a PCP as a main provider completed the PCCQ and reported high scores on its five subscales. In multivariate analysis, lower FACT-C QOL scores (OR 2.72, CI 1.12–6.57) and male gender (OR 2.82, CI 1.11–7.18) predicted poorer evaluations of continuity of care. Concern was highest regarding sexual function, body image, fatigue, impact on work and recreation, and bowel control, and in those who were younger or with rectal cancer.
The organization of CRC follow-up care between providers is complex and variable, but patients followed by PCPs evaluate their transitions of care after treatment favorably. Specific clinical issues and higher risk groups are identified and may benefit from specific attention from all providers.
Implications for cancer survivors
Most CRC survivors are satisfied when their primary care provider becomes responsible for follow-up care. However, this is less true for those who are having more challenges in recovery. These survivors should ensure that information transfer and support services are identified that will smooth this transition.
This is a preview of subscription content,to check access.
Access this article
Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011. 2011.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29.
Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Washington: National Academies Press; 2006.
Khawaja MS. The mediating role of positive and negative emotional attractors between psychosocial correlates of doctor–patient relationship and treatment adherence in type 2 diabetes. Cleveland: Case Western Reserve University; 2011.
Del Giudice ME, Grunfeld E, Harvey BJ, Piliotis E, Verma S. Primary care physicians’ views of routine follow-up care of cancer survivors. J Clin Oncol. 2009;27(20):3338–45.
Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol. 2008;26(7):1073–9.
Sisler J, Seo B, Katz A, Shu E, Chateau D, Czaykowski P, et al. Concordance with ASCO guidelines for surveillance after colorectal cancer treatment: a population-based analysis. J Oncol Pract 2011. Published ahead of print January 31, 2012; JOP.2011.000396.
Cooper GS, Kou TD, Reynolds Jr HL. Receipt of guideline-recommended follow-up in older colorectal cancer survivors: a population-based analysis. Cancer. 2008;113(8):2029–37.
Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor’s perspective. J Clin Oncol. 2011;29(10):1280–9.
Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010(40):25–30.
Baravelli C, Krishnasamy M, Pezaro C, Schofield P, Lotfi-Jam K, Rogers M, et al. The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up. J Cancer Surviv. 2009;3(2):99–108.
Faul LA, Shibata D, Townsend I, Jacobsen PB. Improving survivorship care for patients with colorectal cancer. Cancer Control. 2010;17(1):35–43.
HarrisDecima. Nine in ten Canadians have a family doctor. 2009. http://www.harrisdecima.ca/sites/default/files/releases/061909E.pdf
Dillman DA. Mail and internet surveys: the tailored design method, 2nd ed. New York: Wiley; 2007.
Hadjistavropoulos H, Biem H, Sharpe D, Bourgault-Fagnou M, Janzen J. Patient perceptions of hospital discharge: reliability and validity of a Patient Continuity of Care Questionnaire. Int J Qual Health Care. 2008;20(5):314–23.
Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy—Colorectal (FACT-C) quality of life instrument. Qual Life Res. 1999;8(3):181–95.
Mah K, Bezjak A, Loblaw DA, Gotowiec A, Devins GM. Do ongoing lifestyle disruptions differ across cancer types after the conclusion of cancer treatment? J Cancer Surviv. 2011;5(1):18–26.
Devins GM, Dion R, Pelletier LG, Shapiro CM, Abbey S, Raiz LR, et al. Structure of lifestyle disruptions in chronic disease: a confirmatory factor analysis of the Illness Intrusiveness Ratings Scale. Med Care. 2001;39(10):1097–104.
Martens PJ, Frohlich N, Carriere KC, Derksen S, Brownell M. Embedding child health within a framework of regional health: population health status and sociodemographic indicators. Can J Public Health. 2002;93 Suppl 2:S15–20.
SAS Institute Inc. SAS version 9.2. Copyright 2002–2008.
Desch CE, Benson 3rd AB, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;23(33):8512–9.
Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer. 2004;101(8):1712–9.
Hall SJ, Samuel LM, Murchie P. Toward shared care for people with cancer: developing the model with patients and GPs. Fam Pract. 2011;28(5):554–64.
Hudson SV, Miller SM, Hemler J, Lyle J. "Not what I want, but maybe what I need" Adult cancer survivors discuss follow-up in primary care. Poster presented at the 2010 Meeting of the North American Primary Care Research Group.
Earle CC, Grunfeld E, Coyle D, Cripps MC, Stern HS. Cancer physicians’ attitudes toward colorectal cancer follow-up. Ann Oncol. 2003;14(3):400–5.
Potosky AL, Han PK, Rowland J, Klabunde CN, Smith T, Aziz N, et al. Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med. 2011;26(12):1403–10.
Oeffinger KC, McCabe MS. Models for delivering survivorship care. J Clin Oncol. 2006;24(32):5117–24.
Miedema B, MacDonald I, Tatemichi S. Cancer follow-up care. Patients’ perspectives. Can Fam Physician. 2003;49:890–5.
Grunfeld E, Hodgson DC, Del Giudice ME, Moineddin R. Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract. 2010;6(4):174–81.
Cardella J, Coburn NG, Gagliardi A, Maier BA, Greco E, Last L, et al. Compliance, attitudes and barriers to post-operative colorectal cancer follow-up. J Eval Clin Pract. 2008;14(3):407–15.
Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, et al. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol. 2011;29(36):4755–62.
Berendsen AJ, de Jong GM, Meyboom-de Jong B, Dekker JH, Schuling J. Transition of care: experiences and preferences of patients across the primary/secondary interface—a qualitative study. BMC Health Serv Res. 2009;7:9–62.
Kvamme OJ, Olesen F, Samuelson M. Improving the interface between primary and secondary care: a statement from the European Working Party on Quality in Family Practice (EQuiP). Qual Health Care. 2001;10(1):33–9.
Preston C, Cheater F, Baker R, Hearnshaw H. Left in limbo: patients’ views on care across the primary/secondary interface. Qual Health Care. 1999;8(1):16–21.
Braun TC, Hagen NA, Smith C, Summers N. Oncologists and family physicians. Using a standardized letter to improve communication. Can Fam Physician. 2003;49:882–6.
Harrison SE, Watson EK, Ward AM, Khan NF, Turner D, Adams E, et al. Cancer survivors’ experiences of discharge from hospital follow-up. Eur J Cancer Care. 2012;21:390–7.
Wattchow DA, Weller DP, Esterman A, Pilotto LS, McGorm K, Hammett Z, et al. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer. 2006;94(8):1116–21.
Grunfeld E, Fitzpatrick R, Mant D, Yudkin P, Adewuyi-Dalton R, Stewart J, et al. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Prac. 1999;49(446):705–10.
Caravati-Jouvenceaux A, Launoy G, Klein D, Henry-Amar M, Abeilard E, Danzon A, et al. Health-related quality of life among long-term survivors of colorectal cancer: a population-based study. Oncologist. 2011;16(11):1626–36.
Donovan KA, Thompson LM, Hoffe SE. Sexual function in colorectal cancer survivors. Cancer Control. 2010;17(1):44–51.
Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw. 2009;7(8):883–93. quiz 894.
Schneider EC, Malin JL, Kahn KL, Ko CY, Adams J, Epstein AM. Surviving colorectal cancer: patient-reported symptoms 4years after diagnosis. Cancer. 2007;110(9):2075–82.
McGuiness C, Sibthorpe B. Development and initial validation of a measure of coordination of health care. Int J Qual Health Care. 2003;15(4):309–18.
Cheryl Clague from the Manitoba Cancer Registry organized survey distribution, Gokulan Sivananthan performed a literature review, and Joanne Chateau and Jennifer Enns from the Department of Family Medicine, University of Manitoba assisted in the preparation of the manuscript.
About this article
Cite this article
Sisler, J.J., Taylor-Brown, J., Nugent, Z. et al. Continuity of care of colorectal cancer survivors at the end of treatment: the oncology–primary care interface. J Cancer Surviv 6, 468–475 (2012). https://doi.org/10.1007/s11764-012-0235-9