Oncologists’ and Primary Care Physicians’ Awareness of Late and Long-Term Effects of Chemotherapy: Implications for Care of the Growing Population of Survivors

Copyright © 2013 by American Society of Clinical Oncology

Oncologists’ and Primary Care Physicians’ Awareness of Late and Long-Term Effects of Chemotherapy: Implications for Care of the Growing Population of Survivors

1. Larissa Nekhlyudov, MD, MPH⇑,
2. Noreen M. Aziz, MD, PhD, MPH,
3. Catherine Lerro, MPH and
4. Katherine S. Virgo, PhD, MBA

+ Author Affiliations

1. Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA

1. Corresponding author: Larissa Nekhlyudov, MD, MPH, Department of Population Medicine, Harvard Medical School, 133 Brookline Ave, 6th Floor, Boston MA 02215; e-mail: larissa_nekhlyudov@vmed.org.

Abstract

Purpose: The population of cancer survivors is large and growing. Yet after successful completion of treatment, many experience chemotherapy-related late or long-term effects (LEs). The extent to which physicians are aware of LEs is unknown.

Methods: We conducted a nationally representative survey of 1,130 oncologists and 1,072 primary care providers (PCPs). Respondents were asked to select the LEs they had either observed or seen reported for five chemotherapy agents used to treat breast and colon cancers. We described and compared oncologists’ and PCPs’ awareness of the specified LEs. Using multivariate logistic regression models, we determined predictors of physicians’ awareness of the main LEs associated with the agents.

Results: Almost all oncologists (95%) reported awareness of cardiac dysfunction as an LE of doxorubicin and peripheral neuropathy as an LE of paclitaxel (97%) and oxaliplatin (97%). These LEs were reported by 55%, 27%, and 22% of PCPs, respectively. Most oncologists reported awareness of premature menopause (71%) and secondary malignancies (62%) as LEs of cyclophosphamide, compared with only 15% and 17% of PCPs, respectively. Main LEs associated with all four agents were identified by 65% of oncologists and only 6% of PCPs.

Conclusion: Although more than half of PCPs were aware of cardiac dysfunction as an LE of doxorubicin, awareness of other LEs was limited. Because PCPs may not be directly exposed to chemotherapy-related LEs, oncologists must communicate this information to PCPs as patients transition to primary care settings. Education for all providers caring for the growing population of cancer survivors is needed.