With an estimated 15.5 million cancer survivors living in the United States, caring for survivors is becoming an unmet need, suggesting an increased need for continuing education for oncology and primary care providers that is better focused on this growing population and the special needs associated with survivorship.
Unmet Needs
“Survivors are at greater risk for a variety of issues caused by cancer and its treatment, including long-term and late effects. In recent years, there has been an increased focus on ensuring coordinated care for survivors, but education of health professionals is critical to tackling these issues,” said Allison Harvey, MPH, CHES, Senior Manager, Health Care Professional Education, George Washington University Cancer Center, Washington, DC, at the 2017 Cancer Survivorship Symposium.
E-Learning Series for Cancer Survivorship
E-learning technology may help address the gaps in provider education. Preliminary outcomes among primary care and oncology providers who participated in the Cancer Survivorship E-Learning Series for Primary Care Providers demonstrated significant improvements in knowledge, reported Ms Harvey.
Launched in 2013, the Cancer Survivorship E-Learning Series for Primary Care Providers is part of the National Cancer Survivorship Resource Center, a collaboration between the American Cancer Society, the George Washington Cancer Center, and the Centers for Disease Control and Prevention. Although it was originally developed for primary care providers, said Ms Harvey, different healthcare professionals have participated in the online educational program since its inception. The free continuing education credits available through this program are for all providers.
The E-Learning Series is comprised of 10 modules, each requiring approximately 1 hour. The first 6 modules cover broad topics, including:
- The current state of survivorship care
- Role of primary care providers
- Psychosocial health
- Cancer rehabilitation
- Care coordination.
The latter 4 modules are disease-specific, addressing the needs of survivors with a history of prostate cancer, colorectal cancer, breast cancer, or head and neck cancer.
“Within each module, we offer presentations from national experts. There are also audio interviews with survivors so that providers can connect with patients and get their perspective. Finally, we include a pre and postassessment,” said Ms Harvey.
Preliminary Outcomes
Of the 730 professionals who participated in the program, 593 were oncology care providers and 137 were primary care providers. The majority (79%) of oncology providers were advanced practice nurses, whereas primary care providers were more evenly split between physicians (36%) and nurses (45%).
Encouraging learning gains were observed among primary care and oncology care providers, and for the majority of the learning objectives, primary care and oncology care providers had equivalent gains from preassessment to postassessment.
However, primary care providers had “higher gains in confidence in being able to describe common, late effects after treatment compared with oncology providers” (P <.001), reported Ms Harvey. Conversely, oncology care providers had a significant increase in confidence in being able to describe the roles of primary care providers that are involved in survivorship care.
“Results indicate that the E-Learning Series is effective in improving providers’ self-efficacy around meeting the needs of survivors and engaging in recommended care practices. There is a need for continued dissemination among providers, particularly those in primary care,” said Ms Harvey.
Are Electronic Tools Enough?
Tara O. Henderson, MD, MPH, Director, Childhood Cancer Survivor Center, University of Chicago, IL, discussed this study, highlighting recent research that suggests that primary care physicians and oncologists have “very different perceptions about their knowledge of survivorship care,” with primary care physicians feeling less confident than oncologists, she said.
Furthermore, when Dr Henderson and colleagues tested this knowledge via a survey, only 5% of internal medicine physicians and 2% of family physicians were concordant with long-term follow-up guidelines for survivors of childhood cancer.
In addition, although pediatric oncologists performed better than primary care providers, only 33% of pediatric oncologists were concordant with the survivorship guidelines.
“This shows there are still significant gaps in providers’ knowledge of taking care of these patients. Even oncology providers have a lot of work left to understand some of these long-term effect issues,” said Dr Henderson.
Although the early data suggest that e-tools for oncology and primary care providers can be successful, more approaches are needed.
“Medical student, graduate medical education, and CME [continuing medical education] curricula really need to be in place across the board in North America. This learning is critical for taking care of the growing population of cancer survivors,” added Dr Henderson.
Resources
Communication among providers also needs to improve, she stated. In one survey, general internists reported receiving a treatment summary or letter from oncologists in fewer than 15% of the time.
“Finally, we need to think about dissemination strategies. We might be able to show that these tools are effective in research, but unless we can disseminate them, they’re not useful for all our patients,” said Dr Henderson.
To help promote the dissemination of e-learning tools, several websites for professionals are available:
- George Washington Cancer Center E-Learning Series
- American Cancer Society Survivorship Care Guidelines
- The National Cancer Survivorship Center, which includes survivorship checklists for providers and for patients.