Primary care docs participating in breast cancer decisions

Most women in a new U.S. survey said their primary care physician was involved in their breast cancer care during treatment, and rated their doctor's engagement and communication levels as high.

Researchers found, though, that more primary care provider (PCP) involvement was only tied to a better perception of treatment decisions by the survey participants, who all had newly diagnosed breast cancer, when compared to low PCP involvement.

"While we hypothesized that many women receive high quality primary care during breast cancer treatment, we were surprised that the majority of women in our study also reported high levels of engagement and communication with their PCP during cancer treatment, when the care is typically focused primarily on treating the cancer," said lead author Lauren P. Wallner of the University of Michigan in Ann Arbor.

"In team-based cancer care, oncology care teams work together with primary care and other specialty care teams to ensure patients receive high-quality, coordinated cancer care," she said.

The researchers randomly surveyed more than 2,000 women six months after their breast cancer diagnosis, finding them via registries in California and Georgia in 2013 and 2014. The mailed surveys included six questions about primary care provider access and awareness and three questions about doctors' involvement in treatment. The participants rated how informed their primary care doctors were about breast cancer, how often they talked with their primary care doctors and how often doctors were involved in treatment decisions.

Most women were white and over age 55, had private insurance and some college education.

More than 60 percent of women said their primary care quality was high, and their doctors were highly informed and highly communicative. About 35 percent said doctors participated considerably in treatment decisions. More decision participation tended to align with higher rating of primary care quality, according to the results published in the Journal of Clinical Oncology.

Primary care doctors often know the patient best and are most attuned to their values, preferences and needs, Wallner said, but how involved they should be during treatment depends upon the patient's clinical situation, including whether they have other medical conditions and the preferences of the patient, their oncologist and the primary care doctor.

"As mentioned by the authors, PCPs often play a limited role in treatment decisions, as most breast cancer treatments are fairly standard and patients often just have to agree to receive the treatment prescribed," said Dr. Lisa Del Giudice of Sunnybrook Health Sciences Center at the University of Toronto, who was not part of the new study. "Furthermore, many patients will receive all the information that they need to make an informed decision from their oncologists or other resources."

But PCPs can and should be more directly involved in breast cancer treatment decisions, especially among vulnerable populations, including minority women, those with less education and more health conditions, Del Giudice said.

"Understanding how patients perceive their PCPs' involvement in their cancer care during treatment is important because it allows us to identify areas that need improvement," Wallner told Reuters Health by email. "We can then design interventions to promote the involvement of the PCP and improve the quality of cancer care."

"These findings are reassuring in that women with breast cancer in our study received high quality primary care during treatment," Wallner said. "However, in order to support and encourage PCPs to participate in team-based cancer care, efforts need to be made to better incorporate PCPs, communicate with them, and educate them about the specifics of cancer treatments."