title: The interface of primary and oncology specialty care: from diagnosis through primary treatment.
abstract: In this article, we review the challenges and opportunities related to developing effective, collaborative relationships between primary care and oncology providers during the initial cancer treatment period. This point in the cancer care continuum is complex and often represents the first major transition in care between primary care providers and oncology specialists. Patients often receive care from multiple providers in a number of different settings and are faced with making treatment decisions in a short, concentrated period of time. Patients consistently report having significant informational and emotional needs that are often unmet during this period. Using the published literature, we have identified a number of challenges during this part of the treatment continuum that may limit providers' ability to deliver effective care, including provider care discontinuities, information exchange problems, and gaps in provider role clarity that may be especially problematic within the context of managing comorbid health conditions. The limited published literature specific to this step in the cancer care trajectory supports the importance of ongoing primary care-specialist collaboration during this phase in the care continuum for both medical and psychosocial care. How to best achieve effective collaboration between providers requires further research in information exchange and tools to support it, evaluation of shared care models specific to the cancer context, and studies of the potential role of multidisciplinary case conferencing that include the primary care provider.
authors.affiliation: CCFP, Supportive Cancer Care Research Unit, Department of Oncology, McMaster University, Juravinski Cancer Centre, 4th Floor, 699 Concession St, Hamilton, ON, Canada. jonathan.sussman@jcc.hhsc.ca
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D003191:Comprehensive Health Care; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D055088:Early Detection of Cancer; D005544:Forecasting; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D008495:Medical Oncology; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010346:Patient Care Management; D010348:Patient Care Team / Q000191:economics; D011320:Primary Health Care; D012017:Referral and Consultation; D012944:Social Support; D017664:Uncompensated Care
references.citation: Cancer. 2000 Jan 1;88(1):226-37
references.pmid: 10618627
references.citation: Ann Fam Med. 2003 Sep-Oct;1(3):131-3
references.pmid: 15043373
references.citation: Cancer. 2004 Oct 15;101(8):1712-9
references.pmid: 15386307
references.citation: Am Fam Physician. 2007 Apr 15;75(8):1207-14
references.pmid: 17477104
references.citation: Hosp Q. 2000 Summer;3(4):39-46
references.pmid: 11482268
references.citation: Intern Med J. 2005 Aug;35(8):491-6
references.pmid: 16176475
references.citation: J Clin Oncol. 2004 Feb 15;22(4):714-24
references.pmid: 14966096
references.citation: BMC Med Inform Decis Mak. 2003 Jun 19;3:7
references.pmid: 12816548
references.citation: Cancer Prev Control. 1999 Apr;3(2):137-44
references.pmid: 10474761
references.citation: Am J Med. 2001 Feb 15;110(3):181-7
references.pmid: 11182103
references.citation: Aust Fam Physician. 2005 Apr;34(4):299-300, 302
references.pmid: 15861760
references.citation: J Clin Oncol. 2004 Aug 1;22(15):2992-6
references.pmid: 15284250
references.citation: Br J Gen Pract. 2003 Sep;53(494):723-9
references.pmid: 15103882
references.citation: Scand J Prim Health Care. 2000 Sep;18(3):143-8
references.pmid: 11097098
references.citation: J Gen Intern Med. 2009 Sep;24(9):1029-36
references.pmid: 19597893
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):81-9
references.pmid: 20386056
references.citation: Br J Cancer. 1999 May;80(3-4):427-37
references.pmid: 10408849
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):567-77
references.pmid: 19276017
references.citation: Support Care Cancer. 2004 Sep;12(9):669-73
references.pmid: 15138865
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004910
references.pmid: 17636778
references.citation: J Pain Symptom Manage. 2004 Nov;28(5):421-32
references.pmid: 15504619
references.citation: Can Fam Physician. 2003 Jul;49:890-5
references.pmid: 12901486
references.citation: J Natl Cancer Inst. 2008 Jan 2;100(1):4-5
references.pmid: 18159065
references.citation: Fam Med. 2007 Feb;39(2):126-31
references.pmid: 17273955
references.citation: BMJ. 2003 Nov 22;327(7425):1219-21
references.pmid: 14630762
references.citation: Can Fam Physician. 2004 Jun;50:889-96
references.pmid: 15233372
references.citation: J Clin Oncol. 2009 Mar 1;27(7):1054-61
references.pmid: 19164212
references.citation: J Clin Oncol. 2007 May 10;25(14):1876-81
references.pmid: 17488986
references.citation: Scand J Prim Health Care. 2003 Jun;21(2):110-4
references.pmid: 12877375
references.citation: JAMA. 2004 May 26;291(20):2441-7
references.pmid: 15161894
references.citation: Aust Health Rev. 2000;23(1):163-78
references.pmid: 10947600
references.citation: Can Fam Physician. 2003 Jul;49:882-6
references.pmid: 12901484
references.citation: JAMA. 2002 Oct 9;288(14):1775-9
references.pmid: 12365965
references.citation: J Clin Oncol. 2008 May 10;26(14):2272-7
references.pmid: 18467717
references.citation: Br Med J (Clin Res Ed). 1988 Jan 9;296(6615):97-8
references.pmid: 3122972
references.citation: Qual Saf Health Care. 2003 Aug;12(4):263-72
references.pmid: 12897359
references.citation: J Clin Oncol. 2008 May 10;26(14):2246-7
references.pmid: 18467713
references.citation: BMC Fam Pract. 2006 Mar 21;7:19
references.pmid: 16549036