title: Differences between nurse practitioner and physician care providers on rates of secondary cancer screening and discussion of lifestyle changes among breast cancer survivors.
abstract: OBJECTIVE
  Breast cancer survivorship care is provided by surgical and medical oncologists, primary care physicians (PCPs), and nurse practitioner survivorship specialists (NPs). The study objective was to identify whether frequency of cancer screening and discussion of healthy lifestyles differed across these provider types. We also determined differences by provider in survivor reported follow through with lifestyle recommendations.
  
  
  METHODS
  Breast cancer survivors completed surveys regarding the type of health-care provider they most recently saw, cancer screening, discussion, and self-reported lifestyle change since their breast cancer diagnosis.
  
  
  RESULTS
  Seven hundred fifty-nine breast cancer survivors (78.7 % of those invited) completed the survey; 51.8 % indicated that their last visit was with a medical oncologist. There was no difference in rates of cancer screening (colon, cervical, and breast) among types of providers. A significantly larger proportion of patients who last saw an NP reported that they had discussed physical activity (78.6 %) as compared to medical oncologist 54.4 %, surgeon 43.1 %, radiation oncologist 64.1 %, and PCP 61.3 % (p < 0.001). Similar observations were observed for discussion of nutrition and weight (NP 70.0 %, medical oncologist 36.5 %, surgeon 25.7 %, radiation oncologist 48.7 %, PCP 35.5 %; p < 0.001). There was no significant difference across provider type in self-reported implementation of change in physical activity or diet.
  
  
  CONCLUSIONS
  Our data indicate that a visit to the NP was related to comparable screening rates, but despite that NPs are more often discussing lifestyle modification, self-reported change in nutrition and physical exercise did not differ across provider type.
  
  
  CONCLUSIONS
  NPs perform favorably with respect to lifestyle recommendations. Given the reported lack of lifestyle change, it is important to triage to providers who specialize in lifestyle modification and, if plausible, learn and provide actual evidence-based approaches to achieve positive outcomes in this area.
authors.affiliation: Departments of Family Medicine and Community Health, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Kenison
authors.forename: Paula
authors.initials: P
authors.lastname: Silverman
authors.forename: Marla
authors.initials: M
authors.lastname: Sustin
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000193:education / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000534:rehabilitation; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology; D009722:Nurse Practitioners; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D013038:Specialization / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D017741:Survivors