Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.

Surveillance approaches among colorectal cancer survivors after curative-intent.

Intensive surveillance among colorectal cancer patients receiving curative-intent, particularly during the first 2 to 3 years of follow-up, has a beneficial impact upon all-cause survival at five years. Intensive surveillance appears to be associated with the early detection of recurrences, and more often accompanied by a clinical presentation enabling surgical resection. The optimal combination and frequency of surveillance tests is unknown. Imaging of the chest and abdomen have increasingly been recommended by professional organizations, in addition to CEA levels, in order to detect resectable recurrences. Metachronous cancers are relatively uncommon, nonetheless, surveillance colonoscopy is typically recommended. Cau-tion is warranted in further advancing the intensity of surveillance, as increasingly aggressive surveillance programs risk increased detection of pseudodisease. Different types of information will enhance our understanding of the impact of follow-up programs, including data regarding quality of life, cost, and patient preferences.