primary care physician

Systems Strategies To Support Cancer Screening in U.S. Primary Care Practice

Cancer Epidemiol Biomarkers Prev. 2011 Oct 5

Yabroff R, Zapka JM, Klabunde C, Yuan G, Buckman D, Haggstrom D,  Clauser S, Miller JW, Taplin S.


Division of Cancer Control and Population Sciences, National Cancer  Institute.



Although systems strategies are effective in improving health care  delivery, little is known about their use for cancer screening in U.S. primary care practice.


We assessed primary care physicians’ (n=2475) use of systems strategies for breast, cervical and colorectal cancer (CRC) screening  in a national survey conducted in 2007. Systems strategies included patient and physician screening reminders, performance reports of screening rates, electronic medical records, implementation of  in-practice guidelines, and use of nurse practitioners/physician assistants. We evaluated use of both patient and physician screening reminders with other strategies in separate models by screening type, adjusted for the effects of physician and practice characteristics with multivariate logistic regression.


Fewer than 10% of physicians used a comprehensive set of systems strategies to support cancer screening; use was greater for mammography and Pap testing than for CRC screening. In adjusted analyses, performance reports of cancer screening rates, medical record type, and in-practice guidelines were associated with use of both patient and physician screening reminders for mammography, Pap testing, and CRC screening (p<0.05).


Despite evidence supporting use of systems strategies in primary care, few physicians report using a comprehensive set of strategies to support cancer screening. Impact: Current health policy initiatives underscore the importance of increased implementation of systems strategies in primary care to improve the use and quality of cancer screening in the U.S.

October, 2011|Oral Cancer News|

Finding survivor care

Author: Kathy Latour

In 2006, the Institute of Medicine and National Research Council released From Cancer Patient to Cancer Survivor: Lost in Transition. The goal of the study—the first of its kind—was to examine the range of medical and psychological issues faced by cancer survivors and to make recommendations to improve their health and quality of life.

One such recommendation was to recognize that cancer survivors have unique medical needs and should have available, specialized follow-up care. Since then, clinicians and researchers have begun addressing the issues of who provides survivor care, how that care is delivered and what services should be available.

Each year, an increasing number of cancer centers advertise the addition of survivorship programs. Some focus primarily on quality-of-life issues, while others offer a holistic approach of evaluation and recommendation for follow-up, says Linda Jacobs, PhD, RN, director of one of eight LIVESTRONG Survivorship Centers of Excellence, located at the University of Pennsylvania Abramson Cancer Center in Philadelphia.

“Each emerging program is different,” Jacobs says. “They respond to regional needs as well as the population. Some only focus on one population of survivors, and some only provide services to their own patients.”

This variation in services means survivors “have to have the knowledge to take care of themselves.”

Jacobs says the first step is to document your treatment, either by calling the cancer center where you were treated or by completing a care plan using one of the available tools online, such as the LIVESTRONG Care Plan available at

Another option can be found at from the American Society of Clinical Oncologists.

“Next, you need to understand what you are at risk for and what does the surveillance look like for those issues,” she says. “So, take the care plan to your primary care physician and ask, ‘What am I at risk for based on the exposure I had?’”

This discussion may also bring up necessary tests to serve as a baseline, Jacobs says. For example, if the heart was in the radiation field, Jacobs says, an echocardiogram will give an assessment and serve as a baseline since these late effects don’t generally show up for a decade. A lipid profile is also needed, as are baselines for thyroid and lung.

Survivors also need to be prepared for the fact that some primary care physicians may not understand the need for monitoring or risk assessment—or may not feel confident making a recommendation.

“We see that as part of the problem,” she says. “Primary care providers don’t know what to look for or don’t have the confidence that’s needed to proceed. At this point, the patient needs to say, ‘I have read X,Y, Z, and I need to know what you think.’”

Survivorship researchers are working toward what Jacobs calls “catching these physicians up with the needs of their patients,” giving as an example a California continuing medical education program for primary care physicians to learn about late effects and how to prevent, monitor and treat them.

Source: Cure Magazine, Winter 2010
But the bottom line remains that patients have to advocate for themselves.

January, 2011|Oral Cancer News|