title: Role of oncologists and primary care physicians in providing follow-up care to non-Hodgkin lymphoma survivors within 5 years of diagnosis: a population-based study.
abstract: OBJECTIVE
  The growing population of non-Hodgkin lymphoma (NHL) survivors living longer with high physical and psychological treatment burden, in combination with the projected shortage of medical professionals, necessitates redesigning cancer follow-up care. This study examined follow-up care patterns, factors associated with follow-up care, and attitudes towards follow-up care among NHL survivors.
  
  
  METHODS
  We surveyed survivors of aggressive NHL 2 to 5 years post-diagnosis (N = 363) using a population-based sample from the Los Angeles County Surveillance Epidemiology and End Results registry.
  
  
  RESULTS
  Most survivors (82 %) received cancer-related follow-up care in the past year from an oncologist. History of recurrence, more comorbidities, more symptoms, and a shorter survivor-oncologist relationship were associated with high-frequency care with the oncologist [(≥5 visits in the past year), p < 0.05]. Many survivors followed up by oncologists (71 %) also saw a primary care provider (PCP) and 47 % also saw both a PCP and other specialists. Factors associated with seeing a PCP in addition to an oncologist included more symptoms, more health information needs, no history of recurrence, perceived excellent quality of cancer follow-up care, and fewer visits with the oncologist (p < 0.05). Survivors generally reported high reassurance from, and low negative anticipation towards, follow-up care.
  
  
  CONCLUSIONS
  The high proportion of NHL survivors receiving care from multiple physicians, and the sizable proportion (∼30 %) who have not recently seen a PCP, suggests that coordinating care across specialties is critical to ensure comprehensive, non-duplicative care. Understanding factors associated with cancer-related follow-up is a first step towards more effective, efficient, patient-centered care.
authors.affiliation: Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Suite 900, Washington, DC, 20036, USA, lforsythe@pcori.org.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Forsythe
authors.forename: Neeraj K
authors.initials: NK
authors.lastname: Arora
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Noreen
authors.initials: N
authors.lastname: Aziz
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
mesh_terms: D000368:Aged; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D018802:Patient-Centered Care / Q000379:methods*; D058007:Physicians, Primary Care; D012042:Registries; D018426:SEER Program; D013038:Specialization; D017741:Survivors