Oncology Overhaul: Survivors need more practitioners

In the United States, about 6.5 million cancer survivors are 65 years or older. Approximately 43% of these seniors survive more than 10 years, and approximately 17% survive more than 20 years from the time of their initial diagnosis, as reported in a December 2008 supplement to Cancer, "Aging in the Context of Cancer Prevention and Control."

Additionally, a shortage of oncologists creates the classic example of demand exceeding supply.

Dean Bajorin, MD, co-chair of ASCO's Workforce Advisory Group and an attending physician at Memorial Sloan-Kettering Cancer Center, says that oncologists should be responsible for long-term surveillance of cancer patients, including recurrence of the disease, monitoring, side effects and chemotherapy. PCPs should oversee survivorship plans, and non-physician practitioners should be responsible for some care provision, he says.

Dr. Bajorin is not advocating one model over another but cautions oncology practices to determine their needs, resources and the impact a program might have on patients.

"I am confident that in two years, we will have identified the best way to proceed in the care of cancer patients," he says. "Our goal is to open up dialogue among stakeholders and determine how we can best work together. Team care is the fabric of oncology care."

He predicts that over time, cancer care will become more diverse, assign more responsibility to mid-level practitioners and rely more on data.

A self-administered survey mailed to 405 Denver-based community and academic general internists who provide the bulk of care for long-term cancer survivors, shows that only 18.4% of respondents routinely address three of four areas discussed in the survey: screening management of late effects; sexual functioning; fertility; and mental health. Dana-Farber Cancer Center researchers note a need for increased training in survivorship care to fill the needs of cancer patients once active therapy has ended.

With oncologists facing an overload of cancer patients and a predicted shortage of fellow physicians, the primary care physician might seem to be the logical substitute. Patrick Cobb, MD, president, Community Oncology Alliance, a national advocacy group for cancer patients and professionals, disagrees.