title: Are primary care providers prepared to care for survivors of breast cancer in the safety net?
abstract: BACKGROUND
  With the growing number of survivors of breast cancer outpacing the capacity of oncology providers, there is pressure to transition patients back to primary care. Primary care providers (PCPs) working in safety-net settings may have less experience treating survivors, and little is known about their knowledge and views on survivorship care. The current study was performed to determine the knowledge, attitudes, and confidence of PCPs in the safety net at delivering care to survivors of breast cancer.
  
  
  METHODS
  A modified version of the National Cancer Institute's Survey of Physician Attitudes Regarding Care of Cancer Survivors was given to providers at 2 county hospitals and 5 associated clinics (59 providers). Focus groups were held to understand barriers to survivorship care.
  
  
  RESULTS
  Although the majority of providers believed PCPs have the skills necessary to provide cancer-related follow-up, the vast majority were not comfortable providing these services themselves. Providers were adherent to American Society of Clinical Oncology recommendations for mammography (98%) and physical examination (87%); less than one-third were guideline-concordant for laboratory testing and only 6 providers (10%) met all recommendations. PCPs universally requested additional training on clinical guidelines and the provision of written survivorship care plans before transfer. Concerns voiced in qualitative sessions included unfamiliarity with the management of endocrine therapy and confusion regarding who would be responsible for certain aspects of care.
  
  
  CONCLUSIONS
  Safety-net providers currently lack knowledge of and confidence in providing survivorship care to patients with breast cancer. Opportunities exist for additional training in evidence-based guidelines and improved coordination of care between PCPs and oncology specialists.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California; Robert Wood Johnson Foundation Clinical Scholars Program, University of California at Los Angeles, Los Angeles, California.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Dawes
authors.forename: Marian
authors.initials: M
authors.lastname: Hemmelgarn
authors.forename: David K
authors.initials: DK
authors.lastname: Nguyen
authors.forename: Greg D
authors.initials: GD
authors.lastname: Sacks
authors.forename: Sheilah M
authors.initials: SM
authors.lastname: Clayton
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Cope
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017741:Survivors / Q000523:psychology*
keywords: breast cancer; primary care physicians; safety-net providers; survivorship