How Cancer Survivors’ Challenges After Treatment Impact Transition to Primary Care-led Follow-up Care

Abstract

Background and Rationale: The transition of cancer survivors from oncology-led care to primary care-led follow-up care is a complex process that can significantly impact their well-being and outcomes. This study aimed to investigate how the transition status of a cancer survivor differs according to the challenges they face and their individual circumstances. The goal was to identify associations between survivor-reported challenges and the transition to primary care-led follow-up care. Additionally, the study explored what influence these challenges or circumstances have on oncologist’s decisions to transition cancer survivors from follow-up care at cancer centres to primary care. Methods: This research utilized a novel approach, linking administrative health data with responses from the comprehensive Canadian Transitions Survey (CTS) to gain comprehensive insights into the cancer survivor population and the factors associated with whether they have been transitioned from oncologist-led care to primary-led care. The CTS provided individual-level data on survivor-reported challenges and experiences with follow-up care. The administrative data provided information on individuals’ disease-specific information and healthcare visits. Regression analyses were conducted to assess if challenges and circumstances were associated with transition status (yes/no). An oncologist survey and expert discussions were used to explore the factors influencing transition decisions.Results: The study found no significant association between reported challenges or circumstances and transition status. Common challenges, such as fatigue and fear of recurrence, were prevalent across cancer types and transition statuses. Logistic regression analyses indicated that challenges were not associated with transition status. The oncologist survey and discussions highlighted the pivotal role of access to primary care providers in transition decisions, potentially overriding the impact of a survivor’s individual challenges and circumstances. Conclusion: The study highlights the complexities surrounding the transition of survivors and the decisions made by oncologists regarding their transition. The findings suggest that challenges reported by survivors may not be the primary drivers of transition to primary care. The lack of consensus among oncologists on relevant challenges and circumstances for transitioning survivors coupled with the high number of challenges being reported regardless of transition status highlights the need for a personalized approach to survivor care. The study’s strengths lie in the unique data linkage, allowing for a comprehensive analysis, and the insights obtained from survivor-reported challenges. These findings have important implications for policymaking, survivorship care reorganization, and the development of more personalized care models for cancer survivors.