Primary Care Physicians’ Perceptions Concerning Engagement in Cancer Survivor Care

Primary Care Physicians’ Perceptions Concerning Engagement in Cancer Survivor Care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Primary Care Physicians’ Perceptions Concerning Engagement in Cancer Survivor Care Miho Kimachi, Kenji Omae, Tsukasa Kamitani, Shingo Fukuma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-161611/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Dec, 2021 Read the published version in Journal of General and Family Medicine → Version 1 posted You are reading this latest preprint version Abstract Purpose Given the growing diversity among cancer survivors and the fact that oncologists typically do not perform long-term care, the expected role of primary care physicians (PCPs) in cancer survivor care is expanding. However, communication and collaboration between oncologists and PCPs is lacking. Therefore, we assessed the perception of cancer survivor care among PCPs. Methods We surveyed 767 Japanese Board-certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs’ perceptions of their role in survivor care. Additionally, we included vignette-based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. Results We obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, >70% of PCPs reported that they were willing to engage in all aspects of survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high-risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40-10.6]) and prostate cancer (4.36 [95% confidence interval 1.51-12.6]) scenarios. Conclusions Our findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated. Cancer Biology Oncology Cancer survivor Follow-up care Oncologist Primary care physician Introduction With recent progress in the field of cancer therapy, the number of cancer survivors has been dramatically increasing [ 1 , 2 ]. “Cancer survivors” are all patients with a history of cancer, from the detection of cancer through the rest of their life after completing active cancer treatment, including surgery, radiation therapy, and chemotherapy. However, details concerning cancer survivor care have not yet been established. With the increasing diversity among cancer survivors, including with regard to their age, disease complications, and socioeconomic status, the issues facing these survivors has similarly diversified. Patients might expect continuous follow-up care to be conducted by their oncologist, but providing comprehensive survivor care aside from active cancer treatment is difficult for oncologists [ 3 , 4 ]. Indeed, the number of visits to an oncologist tends to decline over the years following the completion of active cancer treatment [ 5 , 6 ]. Several previous studies have suggested the need for a more complex and multifaceted approach by healthcare providers to the management of complications and comorbidities, psychological support, daily life, and participation in social activities, including returning to work (RTW), among cancer survivors [ 7 , 8 ]. Encouragement concerning RTW or continued employment after RTW among cancer survivors helps support their feelings regarding overcoming their diseases and boosts their confidence in living their life after completing active cancer treatment [ 9 , 10 ]. Oncologists therefore need to cooperate with other physicians, particularly primary care physicians (PCPs), to provide comprehensive cancer survivor care that suits survivors’ interpersonal characteristics [ 11 ]. PCPs in several western countries oversee more cancer survivors than those in Japan [ 12 – 15 ]. However, the gap in perception between PCPs and oncologists is substantial, as the division of roles between PCPs and oncologists has not been definitively established [ 13 , 15 ]. In addition, multimorbidity and aging might complicate PCPs’ referral behaviors to oncologists [ 16 , 17 ]. Oncologists need more opportunities to communicate with PCPs and be aware of PCPs’ perceptions concerning cancer survivor care. Here, we surveyed PCPs’ perceptions concerning cancer survivor care and explored predictors influenced these perceptions using vignette-based scenarios. Materials And Methods Study setting and design We sent a questionnaire to 767 Japanese Board-certified PCPs in Japan, regardless of facility type (clinics and hospitals), using an e-mail distribution list obtained from the Japan Primary Care Association (JPCA) in December 2019. PCPs responded to the questionnaires online within a month of receipt. We informed PCPs about this study’s aim using a cover letter in the introduction section of the questionnaire. We provided a financial incentive of a chance to receive a 2,000-yen Amazon.co.jp gift card, which would be given to 50 randomly selected respondents. The study’s conduct was approved by the Kyoto University Graduate School and Faculty of Medicine Ethics Committee (Approval Numbers R1618) and complied with the Declaration of Helsinki. Characteristics of PCPs and their perceptions of cancer survivor care We surveyed the characteristics of PCPs using a self-reported questionnaire. Questionnaires related to PCPs inquired about gender, years of experience as a physician, facility type, implementation of home medical care, distance to the nearest cooperative cancer institution, and the number of cancer survivors they encountered in their actual practices. Further, we assessed perceptions concerning whether PCPs or oncologists should engage in certain aspects of cancer survivor care, separated by the following three periods: During active cancer treatment: the period in which a cancer survivor actively receives cancer treatment High risk: the period after completing cancer treatment in which a cancer survivor is in a stable general condition but has a high risk of recurrence Low risk: the period after completing cancer treatment in which a cancer survivor has a low risk of recurrence We also assessed the actual feasibility of such engagement in respondents’ facilities should the PCPs receive a request from an oncologist (Supplement 1). Cancer treatment was considered to include surgery, radiation therapy, and chemotherapy. In addition, we asked PCPs what kind of information about cancer survivors they wished to receive from oncologists when they conducted survivor care. Vignette-based scenarios We asked PCPs about their preferences and typical clinical decision they might make for the following hypothetical circumstances using vignette-based scenarios (Supplement 2) [18-20]: Screening strategy for cancer recurrence and referral behavior of a cancer survivor with a history of colorectal cancer (Scenario A) or prostate cancer (Scenario B) to an oncologist Psychosocial support for a cancer survivor with anxiety about cancer recurrence (Scenario C) or with difficulty continuing to work after RTW (Scenario D) We assessed the association between the patient or PCP’s characteristics and the PCP’s behavior pattern adopted on encountering survivors under the given scenarios. In the scenarios regarding cancer screening (Scenarios A and B), we assessed practice patterns, including the implementation of screening and kinds of examinations performed by the PCPs themselves, referral timing to oncologists, and expectations concerning the frequency of examination by an oncologist. We varied the patient characteristics of age (60 or 80 years) and activities of daily living (ADL; able to walk without assistance, or able to walk with assistance or while using a walking stick or other assistive device). Four (2×2) patterns each were thus created for Scenarios A and B. In the scenarios concerning psychosocial support (Scenarios C and D), we assessed the practice patterns of engagement in care for survivors with psychosocial issues by PCPs. We varied the patient characteristics of age (45 or 65 years), gender, and living situation (living with a spouse or living alone). Eight (2×2×2) patterns each were thus created for Scenarios C and D. A total of 1024 pattern combinations (4×4×8×8) from Scenario A to D were created, and responders were randomly provided four types of scenarios. Experts in oncology, general internal medicine, and physical therapy developed the vignette story, and external PCPs and oncologists evaluated the scenario. We revised the questionnaire, including the vignette-based scenario, in accordance with the suggestion of external experts. Statistical analyses With regard to the characteristics of PCPs, continuous data with normal distribution were summarized as mean values (standard deviation [SD]), continuous variables with skewed data as median values with (interquartile range [IQR]), and dichotomous or categorical data as proportions. For the vignette scenario, we calculated the odds ratio (OR) with the 95% confidence interval (CI) to assess the association between patient or PCP characteristics and behavior patterns adopted by PCPs on encountering survivors under the given scenarios, using multivariable logistic regression models. With regard to the screening strategy for the detection of cancer recurrence in Scenarios A and B, we assessed PCP’s behavior pattern concerning whether to perform certain examinations before referring the patient to an oncologist or left all examinations to the oncologist. We adjusted for the patient characteristics of age and ADL in the “minimally adjusted model” and then added physician characteristics of gender, years of physician experience, and facility type (clinic or other) to the “fully adjusted model”. Further, with regard to the psychosocial support referenced in Scenarios C and D, we assessed PCP’s behavior pattern concerning whether to cooperate with or leave matters entirely to other physician, including oncologists, psychiatrists, and occupational health physicians (OHPs). We adjusted for the patient characteristics of age, gender, and living situation in the “minimally adjusted model” and then physician characteristics of gender, years of physician experience, and facility type (clinic or other) to the “fully adjusted model”. All statistical analyses were performed using STATA 16.0 (version 16.0; Stata Corp, College Station, TX, USA). Results Baseline characteristics and PCPs’ perceptions of their role in cancer survivor care We obtained 91 replies (response rate: 11.9%). As shown in Table 1 , the median number of years of healthcare experience was 13 (range: 10 to 15), and almost half of the participants worked in clinics. A total of 77.0% of PCPs reported that the nearest cooperative oncologist was located within 10 km of their facility, and 75% of PCPs had at least 1 cancer patient in their actual practice. Table 1 Baseline characteristics of respondents and their facilities Characteristics Total (n = 91) Male, n (%) 57 (62.6) Years of healthcare experience, years 13.2 [6 to 35] Types of facilities, % Academic medical centers 12 (13.2) General hospitals (national or public hospitals) 18 (19.8) Private hospitals 17 (18.7) Clinics 42 (46.2) Other 2 (2.2) Implementation of home healthcare, % 70 (76.9) Distance to the nearest cooperative institution, % Within own facility 28 (30.8) < 1-km radius 8 (8.8) 1- to < 10-km radius 34 (37.4) 10- to < 50-km radius 18 (19.8) ≥ 50-km radius 3 (3.3) Number of cancer patients overseen, % (n) None 23 (25.3) 1–3 32 (35.2) 4–6 20 (22.0) 7–9 6 (6.6) ≥ 10 10 (11.0) Continuous data with a normal distribution were summarized as the mean (standard deviation), continuous variables with skewed data were summarized as the median (interquartile range), and dichotomous or categorical data were summarized as the proportion As shown in Table 2 , 85.1% of PCPs thought PCPs should not prescribe intravenous anticancer agents, while 42.5% felt that both PCPs and oncologists should be able to prescribe oral anticancer agents. However, over 70% of PCPs reported that PCPs should or both PCPs and oncologists should be able to engage in all aspects of survivor care except for the administration of anticancer drugs during active cancer treatment. Further, more than 90% of PCPs reported that PCPs should or both PCPs and oncologists should be able to engage in almost all aspects of cancer survivor care, including the prescription of regular medications, treatment of cancer complications, nutritional education, and provision of psychosocial support (including RTW), regardless of the degree of recurrence risk after completing active cancer treatment. In addition, PCPs responded that their facilities were equipped with adequate resources to perform such survivor care (see Supplemental Table 3). However, almost half reported feeling that PCPs should not engage in the regular cancer screening of survivors with a high risk of cancer recurrence. Table 2 PCPs’ perceptions regarding whether PCPs or oncologists should perform cancer survivor care during or after cancer therapy (n = 87) Cancer survivor care During cancer therapy High risk Low risk PCP/both Oncologist PCP/both Oncologist PCP/both Oncologist Prescription of oral anticancer agents 37 (42.5) 50 (57.5) - - - - Prescription of intravenous anticancer agents 13 (14.9) 74 (85.1) - - - - Therapy for side effects of anticancer agents 64 (73.6) 23 (26.4) - - - - Prescription of opioid analgesic medications 82 (94.3) 5 (5.8) - - - - Prescription of analgesic medications other than opioid 83 (95.4) 4 (4.6) - - - - Prescription of regular medications other than anticancer agents 86 (98.9) 1 (1.2) 87 (100) 0 85 (97.7) 2 (2.3) Management in case of infection 78 (89.7) 9 (10.3) 86 (98.9) 1 (1.2) 87 (100) 0 (0) Nutritional education 83 (95.4) 4 (4.6) 86 (98.9) 1 (1.2) 87 (100) 0 (0) Stoma care 81 (93.1) 6 (6.9) 84 (96.6) 3 (3.5) 85 (97.7) 2 (2.3) Maintenance or recovery support of patient’s ADL 86 (98.9) 1 (1.2) 85 (98.8) 1 (1.2) 87 (100) 0 (0) Support for the patient’s social reintegration or return to work 84 (96.6) 3 (3.5) 84 (97.7) 2 (2.3) 86 (98.9) 1 (1.2) Psychological support 86 (98.9) 1 (1.2) 87 (100) 0 86 (98.9) 1 (1.2) Regular screening for cancer recurrence - - 43 (49.4) 44 (50.6) 71 (81.6) 16 (18.4) Regular screening for other cancers - - 79 (90.8) 8 (9.2) 81 (93.1) 6 (6.9) PCP, primary care physician; ADL, activities of daily living. Values are summarized as n (%). The follow-up stage was as follows: 1. During active cancer treatment: the period in which a cancer survivor actively receives cancer treatment 2. High risk: the period after completing cancer treatment in which a cancer survivor is in a stable general condition but has a high risk of recurrence 3. Low risk: the period after completing cancer treatment in which a cancer survivor has a low risk of recurrence Roles in cancer survivor care 1. PCP/both: “PCPs should engage in survivor care” or “Both PCPs and oncologist should be able to engage in survivor care” 2. Oncologist: “PCPs should not engage in any care; only oncologists should engage in survivor care.” As shown in Table 3 , PCPs reported needing important information from oncologists concerning survivors, including the status of their cancer and details of the active cancer treatment being given, complications that occurred in the course of cancer treatment or might occur in the future, plans for active cancer treatment, status of chronic diseases other than cancer, and survivor’s psychological status. Few PCPs expected to be provided information about the survivor’s family history of cancer and the results of genetic tests conducted in survivors and their families. Table 3 Relevant information about survivors that PCPs wished to receive from oncologists when they conducted survivor care (n = 87) Number or respondents requesting information, n (%) Type of cancer (e.g. lung cancer, colon cancer) 87 (100) Stage of cancer 85 (97.7) Histological findings of cancer 55 (63.2) Surgical procedures 73 (83.9) Intraoperative process 19 (21.8) Irradiated portion of radiotherapy 77 (88.5) Irradiance level of radiotherapy 39 (44.8) Types of anticancer agents 77 (88.5) Dose of anticancer agents 32 (36.8) Complications associated with cancer therapy 81 (93.1) Side effects that have not appeared yet but might in the future 76 (87.4) Plans for subsequent cancer therapy 83 (95.4) Management in case of infection 65 (74.7) Condition of chronic diseases (e.g. hypertension) during cancer therapy 61 (70.1) Changes in regular medications during cancer therapy 75 (86.2) Family history of cancer 24 (27.6) Results of patient’s genetic tests 35 (40.2) Results of family’s genetic tests 25 (28.7) Patient’s psychological status 73 (83.9) CT, computed tomography; CEA, Carcinoembryonic antigen; CA19-9, Carbohydrate antigen 19 − 9; PSA, Prostate specific antigen Screening Strategy For Cancer Survivors We examined the screening strategy using scenarios concerning a patient with a history of colorectal or prostate cancer (see Supplement 2). The scenario is a hypothetical story about an outpatient with diabetes mellitus and hypertension who underwent surgery for Stage II colorectal cancer (T3N0M0) (Scenario A) or Stage II prostate cancer (T2bN0M0) (Scenario B) two years earlier. As seen in Supplemental Table 4, around 50% PCPs expected an oncologist to examine survivors of both colorectal and prostate cancer once every six months. Supplemental Table 5 shows the “additional” examination types that PCPs are willing to perform by themselves when any abnormal results are obtained by a fecal occult blood test (Scenario A) or a PSA evaluation (Scenario B) as a regular screening test, including findings for tumor marker evaluations (CEA and CA19-9), abdominal CT, and colonoscopy for the colorectal cancer scenario and a urinalysis, blood tests other than PSA measurement, and abdominal ultrasound for the prostate cancer scenario. As shown in Table 4 , a multivariable logistic regression analysis revealed that PCPs in clinics were less willing to screen for cancer recurrence than PCPs in academic medical centers or hospitals for both colorectal and prostate cancer scenarios. However, aside from this difference, we noted no significant association between the hypothetical survivor’s characteristics in the scenario and the referral behavior among PCPs. Table 4 Association between survivor and physician characteristics and referral behavior to an oncologist in vignette-based scenarios regarding screening for cancer recurrence Scenario A (n = 80) Scenario B (n = 86) Minimally adjusted model Odds ratio (95% CI) p-value Odds ratio (95% CI) p-value Older patient age 0.99 (0.94 to 1.03) 0.61 0.98 (0.93 to 1.02) 0.30 Poor ADL 0.34 (0.14 to 0.86) 0.022 0.78 (0.31 to 1.96) 0.60 Fully adjusted model Odds ratio (95% CI) p-value Odds ratio (95% CI) p-value Older patient age 0.97 (0.92 to 1.02) 0.23 1.00 (0.95 to 1.05) 0.97 Poor ADL 0.41 (0.16 to 1.10) 0.077 1.13 (0.41 to 3.11) 0.81 Physicians’ gender (Female) 0.72 (0.26 to 2.03) 0.54 1.17 (0.42 to 3.26) 0.76 Years of physician experience 0.98 (0.89 to 1.08) 0.67 0.97 (0.88 to 1.07) 0.57 Type of facility (Clinics or others) 3.85 (1.40 to 10.6) 0.009 4.36 (1.51 to 12.6) 0.006 CI, confidence interval; ADL, activities of daily living; PCP, primary care physician Scenario A, colorectal cancer scenario; Scenario B, prostate cancer scenario We assessed PCP’s behavior pattern concerning whether to perform certain examinations before referring the patient to an oncologist on encountering survivors under the given scenarios. We compared the selection of “leave all routine screening tests for cancer recurrence to an oncologist” and the selection of “perform some screening tests before referral to an oncologist” as a reference. Psychosocial support for survivors with anxiety concerning cancer recurrence and difficulty continuing to work after RTW Scenario C is a hypothetical story concerning an outpatient with hypertension who had no recurrence findings after cancer treatment but was suffering from sleep disturbance due to anxiety about cancer recurrence. As shown in Table 5 , most PCPs responded that they would set aside time to counsel the survivor in this scenario. In addition, over 40% responded that they would prescribe medication, such as sleep aids, anxiolytics, or antidepressant agents, and around 30% would propose a referral to a psychiatrist or a psychosomatic physician as well as oncologist. Further, more than half of PCPs said they would recommend the patient join a patient advocacy group (PAG). Table 5 Primary care physicians’ usual attitude towards cancer survivors with anxiety about cancer recurrence (Scenario C) or with difficulty continuing to work after RTW (Scenario D) (n = 87) Scenario C Scenario D Set aside time to counsel patients 80 (92.0) 77 (88.5) Prescribe sleep agents 38 (43.7) ― Prescribe anxiolytics or antidepressants 42 (48.3) 21 (24.1) Refer the survivor to a psychiatrist or psychosomatic physician 24 (27.6) 28 (32.2) Advise the survivor to consult an oncologist 30 (34.5) 34 (39.1) Encourage the survivor to join a PAG 44 (50.6) 22 (25.3) Advise the survivor to consult a superior at work ― 52 (59.8) Advise the survivor to consult an OHP or the occupational health center at their workplace ― 66 (75.9) Advise the survivor to check their work rules regarding changes in work shift or contents ― 39 (44.8) Advise the survivor to take leave from work ― 46 (52.9) Contact the survivor’s OHP to explain their medical condition ― 3 (3.5) RTW, return to work; PAG, patient advocacy group; OHP, occupational health physician. Values are summarized as n (%). Scenario D is another hypothetical story concerning a patient with a similar chronic condition to the one in Scenario C; this patient was experiencing difficulty continuing to perform their work as expected after RTW due to feeling tired during the day. Most PCPs responded that they would set aside time to counsel the survivor in this scenario. In addition, over half responded that they would suggest the patient bring up the matter at their workplace, such as through a consultation with their superior or with an OHP at their workplace, as well as recommend taking a leave of absence from work. We were unable to perform multivariable analyses to explore the risk factors that influenced the PCPs’ perceptions concerning whether to cooperate with or leave matters entirely to other physicians with regard to providing psychosocial support, as most PCPs responded that they would be willing to engage in such support if they were to encounter survivors under the given scenarios. Discussion The present study suggested that Japanese PCPs were willing to engage in comprehensive cancer survivor care, regardless of the duration since receiving active cancer treatment. Findings from the vignette-based scenario indicated that PCPs working in clinics were less inclined to conduct screening for recurrence than those working in academic medical centers or hospitals, although we were unable to determine which survivor characteristics more significantly influenced the referral behavior to oncologists. Further, most PCPs were willing to engage in psychosocial support concerning survivors’ anxiety and work-related issues. Several previous studies have reported that oncologists did not expect cancer survivor care to be performed by PCPs, as PCPs’ skills and knowledge concerning survivor care were unclear, even when PCPs showed a willingness to engage in such care [ 12 , 21 ]. Such controversy is considered to reflect poor communication between oncologists and PCPs. However, oncologists might be able to leave various tasks of cancer survivor care to PCPs under expert advice and close cooperation [ 22 , 23 ]. Indeed, the PCPs in the present study mentioned the need for certain important bits of information for the initiation of survivor care, as has also been reported in previous studies [ 14 ]. Vignette-based studies using hypothetical scenarios representing a particular circumstance are useful for assessing preferences, beliefs, and attitudes of subjects [ 18 – 20 , 24 ]. Unfortunately, PCPs in Japan have fewer opportunities to engage in collaboration with oncologists than those in other countries. However, using vignettes, we can assess the variations in practice patterns among cancer survivors even if PCPs do not perform such care in their actual clinical practice. Regarding the screening strategy scenarios, PCPs in clinics showed a greater tendency to leave screening tests to oncologists than PCPs in academic medical centers or hospitals. Oncologists might therefore need to consider the resources available to PCPs. Further, an appropriate recommendation or guideline describing the roles that can be performed by PCPs among different types of facilities should be established. Regarding the psychosocial support scenarios, previous studies showed that cancer survivors expected PCPs (rather than oncologists) to provide emotional support [ 8 , 25 , 26 ]. In particular, encouragement for the improvement of self-efficacy contributed to a higher rate of RTW or continued employment after RTW and a better subsequent quality of life among cancer survivors [ 9 , 10 , 27 – 29 ]. The finding from the vignette-based scenario indicated that PCPs were willing to provide psychosocial care to survivors. However, previous studies have recommended the collaboration between PCPs and other healthcare providers, including oncologists, psychiatrists, and OHPs, as PCPs’ skills and knowledge in this area are unclear [ 26 , 30 ]. A future study should explore the perceptions of other healthcare providers concerning the expected role of PCPs. Several limitations to the present study warrant mention. First, the response rate was quite low. Participants in the questionnaire were likely to be concerned with caring for cancer survivors, which might lead to selection bias. Second, in the vignette-based scenarios, we only examined two types of cancer that are relatively common in Japan, which might reduce the generalizability. However, we feel that the results of this study are representative of all cancer survivors and can be applied to patients with other cancer types, except for cancer screening, as patients with colorectal or prostate cancer tend to have a relatively high survival rate and a long remainder of life [ 31 , 32 ]. Third, the factors related to the patient characteristics included in the scenario were limited: age and ADL for Scenarios A and B and age, gender, and living style for Scenarios C and D. Finally, the responses given to vignette-based scenario are not always identical to respondents’ actual practice patterns. However, the findings from this study might highlight the need for further clarification of roles and the establishment of a cooperative framework between PCPs and oncologists for cancer survivor care. Conclusions PCPs in Japan are willing to engage in comprehensive cancer survivor care, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care using PCPs’ willingness and capabilities. A future study should evaluate the perceptions of oncologists concerning how much survivor care they feel can be left to PCPs. Declarations Acknowledgements We thank Takuya Aoki, Hidetaka Kawamura, Yujiro Nakayama, Taro Takeshima, and Takashi Yoshioka for their expert advice in developing the scenarios used in the present study. In addition, we sincerely appreciate the cooperation of the participants. Funding This study was supported by scientific research grants from Japan Primary Care Association. Conflict of interest The authors declare no conflict of interests for this article. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Availability of data and material Our manuscripts has data included as electronic supplementary material. Code availability All statistical analyses were performed using STATA 16.0 (version 16.0; Stata Corp, College Station, TX, USA) Ethics approval The questionnaire and methodology for this study was approved by the Kyoto University Graduate School and Faculty of Medicine Ethics Committee (Approval Numbers R1618). Consent to participate and/or Consent for publication We informed the participants about this study’s aim and publishing their data using a cover letter in the introduction section of the questionnaire. We regarded return of the questionnaire as their consent to participate in this study. In addition, we did not include personally identifiable information in our manuscript and electronic supplementary materials. Authors’ contributions All authors contributed to the study conception and design. Data was collected by Miho Kimachi. 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BMC Fam Pract 15: 28 de Kock CA, Lucassen PL, Spinnewijn L et al (2016) How do Dutch GPs address work-related problems? A focus group study. Eur J Gen Pract 22(3):169-175 Lin JS, Piper MA, Perdue LA et al (2016) Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 315(23):2576-2594 Provenzale D, Jasperson K, Ahnen DJ et al; National comprehensive cancer netwok (2015) Colorectal Cancer Screening, Version 1.2015. J Natl Compr Canc Netw 13(8):959-968 Supplementary Files Supplement1SCC.pdf Supplement2SCC.pdf Supplement3SCC.pdf Supplement4SCC.pdf Supplement5SCC.pdf datasheet.xlsx Cite Share Download PDF Status: Published Journal Publication published 22 Dec, 2021 Read the published version in Journal of General and Family Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-161611","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":10796567,"identity":"c2eea949-6d58-4491-a0b5-ddd657315a30","order_by":0,"name":"Miho Kimachi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACxgYEycBwQA5MPiBFizGYTCDaLqDiRDADnxb+GcnNH39UMMj2M/Aek7q54076/LDDD4G22MnpNmDXInEjsU2a5wyD8cwGvjTp3DPPcjfeTjMAakk2NjuAXYuBRGIbM2MbQ+KGAzxm0rlth3M3zk4AaTmQuA23luaPP/8xJO6Hakk3nJ3+gZCWBgneBqAtDBAtCfLSOfhtkTjzEOiXYxLGMw7zGFvnnjlsuEE6p+BAggFuv/C3pz/++KPGRra/vcfwdu6Ow/Lys9M3f/hQYSeHSwvMMgYGZgYWCVDsGIBVGuBVDgfMH0Ba5BuIUz0KRsEoGAUjBwAAsEBkvKLrplAAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-3732-452X","institution":"Kyoto University: Kyoto Daigaku","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Miho","middleName":"","lastName":"Kimachi","suffix":""},{"id":10796568,"identity":"8f544d83-c09d-4097-a8a3-2bc04e797445","order_by":1,"name":"Kenji Omae","email":"","orcid":"","institution":"Fukushima Kenritsu Ika Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kenji","middleName":"","lastName":"Omae","suffix":""},{"id":10796569,"identity":"f0c79c67-0048-4763-bfd6-cc783f425c1f","order_by":2,"name":"Tsukasa Kamitani","email":"","orcid":"","institution":"Kyoto University: Kyoto Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tsukasa","middleName":"","lastName":"Kamitani","suffix":""},{"id":10796570,"identity":"f81cc38c-418a-465d-ba94-0800ad6dd1e9","order_by":3,"name":"Shingo Fukuma","email":"","orcid":"","institution":"Kyoto University: Kyoto Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shingo","middleName":"","lastName":"Fukuma","suffix":""}],"badges":[],"createdAt":"2021-01-27 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20:12:43","extension":"pdf","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":78727,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement5SCC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-161611/v1/4fad19e416aaacc106c4b987.pdf"},{"id":5797864,"identity":"7d51d22c-0f87-4423-a6b4-086e08c80b06","added_by":"auto","created_at":"2021-02-09 20:15:43","extension":"xlsx","order_by":13,"title":"","display":"","copyAsset":false,"role":"supplement","size":34399,"visible":true,"origin":"","legend":"","description":"","filename":"datasheet.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-161611/v1/cb8d65555012056b1acbff33.xlsx"}],"financialInterests":"","formattedTitle":"\u003cp\u003ePrimary Care Physicians’ Perceptions Concerning Engagement in Cancer Survivor Care\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eWith recent progress in the field of cancer therapy, the number of cancer survivors has been dramatically increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. \u0026ldquo;Cancer survivors\u0026rdquo; are all patients with a history of cancer, from the detection of cancer through the rest of their life after completing active cancer treatment, including surgery, radiation therapy, and chemotherapy. However, details concerning cancer survivor care have not yet been established. With the increasing diversity among cancer survivors, including with regard to their age, disease complications, and socioeconomic status, the issues facing these survivors has similarly diversified. Patients might expect continuous follow-up care to be conducted by their oncologist, but providing comprehensive survivor care aside from active cancer treatment is difficult for oncologists [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Indeed, the number of visits to an oncologist tends to decline over the years following the completion of active cancer treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral previous studies have suggested the need for a more complex and multifaceted approach by healthcare providers to the management of complications and comorbidities, psychological support, daily life, and participation in social activities, including returning to work (RTW), among cancer survivors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Encouragement concerning RTW or continued employment after RTW among cancer survivors helps support their feelings regarding overcoming their diseases and boosts their confidence in living their life after completing active cancer treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Oncologists therefore need to cooperate with other physicians, particularly primary care physicians (PCPs), to provide comprehensive cancer survivor care that suits survivors\u0026rsquo; interpersonal characteristics [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePCPs in several western countries oversee more cancer survivors than those in Japan [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the gap in perception between PCPs and oncologists is substantial, as the division of roles between PCPs and oncologists has not been definitively established [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In addition, multimorbidity and aging might complicate PCPs\u0026rsquo; referral behaviors to oncologists [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Oncologists need more opportunities to communicate with PCPs and be aware of PCPs\u0026rsquo; perceptions concerning cancer survivor care.\u003c/p\u003e \u003cp\u003eHere, we surveyed PCPs\u0026rsquo; perceptions concerning cancer survivor care and explored predictors influenced these perceptions using vignette-based scenarios.\u003c/p\u003e "},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sent a questionnaire to 767 Japanese Board-certified PCPs in Japan, regardless of facility type (clinics and hospitals), using an e-mail distribution list obtained from the Japan Primary Care Association (JPCA) in December 2019. PCPs responded to the questionnaires online within a month of receipt. We informed PCPs about this study\u0026rsquo;s aim using a cover letter in the introduction section of the questionnaire. We provided a financial incentive of a chance to receive a 2,000-yen Amazon.co.jp gift card, which would be given to 50 randomly selected respondents.\u003c/p\u003e\n\u003cp\u003eThe study\u0026rsquo;s conduct was approved by the Kyoto University Graduate School and Faculty of Medicine Ethics Committee (Approval Numbers R1618) and complied with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of PCPs and their perceptions of cancer survivor care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe surveyed the characteristics of PCPs using a self-reported questionnaire. Questionnaires related to PCPs inquired about gender, years of experience as a physician, facility type, implementation of home medical care, distance to the nearest cooperative cancer institution, and the number of cancer survivors they encountered in their actual practices. Further, we assessed perceptions concerning whether PCPs or oncologists should engage in certain aspects of cancer survivor care, separated by the following three periods:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eDuring active cancer treatment: the period in which a cancer survivor actively receives cancer treatment\u003c/li\u003e\n\u003cli\u003eHigh risk: the period after completing cancer treatment in which a cancer survivor is in a stable general condition but has a high risk of recurrence\u003c/li\u003e\n\u003cli\u003eLow risk: the period after completing cancer treatment in which a cancer survivor has a low risk of recurrence\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWe also assessed the actual feasibility of such engagement in respondents\u0026rsquo; facilities should the PCPs receive a request from an oncologist (Supplement 1). Cancer treatment was considered to include surgery, radiation therapy, and chemotherapy. In addition, we asked PCPs what kind of information about cancer survivors they wished to receive from oncologists when they conducted survivor care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVignette-based scenarios \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe asked PCPs about their preferences and typical clinical decision they might make for the following hypothetical circumstances using vignette-based scenarios (Supplement 2) [18-20]:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eScreening strategy for cancer recurrence and referral behavior of a cancer survivor with a history of colorectal cancer (Scenario A) or prostate cancer (Scenario B) to an oncologist\u003c/li\u003e\n\u003cli\u003ePsychosocial support for a cancer survivor with anxiety about cancer recurrence (Scenario C) or with difficulty continuing to work after RTW (Scenario D)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWe assessed the association between the patient or PCP\u0026rsquo;s characteristics and the PCP\u0026rsquo;s behavior pattern adopted on encountering survivors under the given scenarios.\u003c/p\u003e\n\u003cp\u003eIn the scenarios regarding cancer screening (Scenarios A and B), we assessed practice patterns, including the implementation of screening and kinds of examinations performed by the PCPs themselves, referral timing to oncologists, and expectations concerning the frequency of examination by an oncologist. We varied the patient characteristics of age (60 or 80 years) and activities of daily living (ADL; able to walk without assistance, or able to walk with assistance or while using a walking stick or other assistive device). Four (2\u0026times;2) patterns each were thus created for Scenarios A and B. In the scenarios concerning psychosocial support (Scenarios C and D), we assessed the practice patterns of engagement in care for survivors with psychosocial issues by PCPs. We varied the patient characteristics of age (45 or 65 years), gender, and living situation (living with a spouse or living alone). Eight (2\u0026times;2\u0026times;2) patterns each were thus created for Scenarios C and D.\u003c/p\u003e\n\u003cp\u003eA total of 1024 pattern combinations (4\u0026times;4\u0026times;8\u0026times;8) from Scenario A to D were created, and responders were randomly provided four types of scenarios. Experts in oncology, general internal medicine, and physical therapy developed the vignette story, and external PCPs and oncologists evaluated the scenario. We revised the questionnaire, including the vignette-based scenario, in accordance with the suggestion of external experts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith regard to the characteristics of PCPs, continuous data with normal distribution were summarized as mean values (standard deviation [SD]), continuous variables with skewed data as median values with (interquartile range [IQR]), and dichotomous or categorical data as proportions.\u003c/p\u003e\n\u003cp\u003eFor the vignette scenario, we calculated the odds ratio (OR) with the 95% confidence interval (CI) to assess the association between patient or PCP characteristics and behavior patterns adopted by PCPs on encountering survivors under the given scenarios, using multivariable logistic regression models. With regard to the screening strategy for the detection of cancer recurrence in Scenarios A and B, we assessed PCP\u0026rsquo;s behavior pattern concerning whether to perform certain examinations before referring the patient to an oncologist or left all examinations to the oncologist. We adjusted for the patient characteristics of age and ADL in the \u0026ldquo;minimally adjusted model\u0026rdquo; and then added physician characteristics of gender, years of physician experience, and facility type (clinic or other) to the \u0026ldquo;fully adjusted model\u0026rdquo;. Further, with regard to the psychosocial support referenced in Scenarios C and D, we assessed PCP\u0026rsquo;s behavior pattern concerning whether to cooperate with or leave matters entirely to other physician, including oncologists, psychiatrists, and occupational health physicians (OHPs). We adjusted for the patient characteristics of age, gender, and living situation in the \u0026ldquo;minimally adjusted model\u0026rdquo; and then physician characteristics of gender, years of physician experience, and facility type (clinic or other) to the \u0026ldquo;fully adjusted model\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using STATA 16.0 (version 16.0; Stata Corp, College Station, TX, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBaseline characteristics and PCPs\u0026rsquo; perceptions of their role in cancer survivor care\u003c/h2\u003e\u003cp\u003eWe obtained 91 replies (response rate: 11.9%). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the median number of years of healthcare experience was 13 (range: 10 to 15), and almost half of the participants worked in clinics. A total of 77.0% of PCPs reported that the nearest cooperative oncologist was located within 10 km of their facility, and 75% of PCPs had at least 1 cancer patient in their actual practice.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of respondents and their facilities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (62.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of healthcare experience, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.2 [6 to 35]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTypes of facilities, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic medical centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral hospitals (national or public hospitals)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (19.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (18.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (46.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImplementation of home healthcare, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (76.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance to the nearest cooperative institution, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin own facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (30.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1-km radius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1- to \u0026lt;\u0026thinsp;10-km radius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (37.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10- to \u0026lt;\u0026thinsp;50-km radius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (19.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50-km radius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of cancer patients overseen, % (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (25.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (35.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (22.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (6.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eContinuous data with a normal distribution were summarized as the mean (standard deviation), continuous variables with skewed data were summarized as the median (interquartile range), and dichotomous or categorical data were summarized as the proportion\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, 85.1% of PCPs thought PCPs should not prescribe intravenous anticancer agents, while 42.5% felt that both PCPs and oncologists should be able to prescribe oral anticancer agents. However, over 70% of PCPs reported that PCPs should or both PCPs and oncologists should be able to engage in all aspects of survivor care except for the administration of anticancer drugs during active cancer treatment. Further, more than 90% of PCPs reported that PCPs should or both PCPs and oncologists should be able to engage in almost all aspects of cancer survivor care, including the prescription of regular medications, treatment of cancer complications, nutritional education, and provision of psychosocial support (including RTW), regardless of the degree of recurrence risk after completing active cancer treatment. In addition, PCPs responded that their facilities were equipped with adequate resources to perform such survivor care (see Supplemental Table\u0026nbsp;3). However, almost half reported feeling that PCPs should not engage in the regular cancer screening of survivors with a high risk of cancer recurrence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePCPs\u0026rsquo; perceptions regarding whether PCPs or oncologists should perform cancer survivor care during or after cancer therapy (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCancer survivor care\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDuring cancer therapy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eHigh risk\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eLow risk\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePCP/both\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eOncologist\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ePCP/both\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eOncologist\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ePCP/both\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eOncologist\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of oral anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of intravenous anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (85.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTherapy for side effects of anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (73.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of opioid analgesic medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (94.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of analgesic medications other than opioid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (95.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of regular medications other than anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85 (97.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement in case of infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutritional education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (95.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStoma care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (93.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (96.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85 (97.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaintenance or recovery support of patient\u0026rsquo;s ADL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 (98.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupport for the patient\u0026rsquo;s social reintegration or return to work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (96.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (97.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86 (98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular screening for cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71 (81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular screening for other cancers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (90.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81 (93.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (6.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003ePCP, primary care physician; ADL, activities of daily living. Values are summarized as n (%).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eThe follow-up stage was as follows:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e1. During active cancer treatment: the period in which a cancer survivor actively receives cancer treatment\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e2. High risk: the period after completing cancer treatment in which a cancer survivor is in a stable general condition but has a high risk of recurrence\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e3. Low risk: the period after completing cancer treatment in which a cancer survivor has a low risk of recurrence\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eRoles in cancer survivor care\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e1. PCP/both: \u0026ldquo;PCPs should engage in survivor care\u0026rdquo; or \u0026ldquo;Both PCPs and oncologist should be able to engage in survivor care\u0026rdquo;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e2. Oncologist: \u0026ldquo;PCPs should not engage in any care; only oncologists should engage in survivor care.\u0026rdquo;\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, PCPs reported needing important information from oncologists concerning survivors, including the status of their cancer and details of the active cancer treatment being given, complications that occurred in the course of cancer treatment or might occur in the future, plans for active cancer treatment, status of chronic diseases other than cancer, and survivor\u0026rsquo;s psychological status. Few PCPs expected to be provided information about the survivor\u0026rsquo;s family history of cancer and the results of genetic tests conducted in survivors and their families.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelevant information about survivors that PCPs wished to receive from oncologists when they conducted survivor care (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber or respondents\u003c/p\u003e\u003cp\u003erequesting information,\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of cancer (e.g. lung cancer, colon cancer)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage of cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (97.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistological findings of cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (63.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical procedures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (83.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative process\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (21.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrradiated portion of radiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (88.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrradiance level of radiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (44.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTypes of anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (88.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDose of anticancer agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (36.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications associated with cancer therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (93.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide effects that have not appeared yet but might in the future\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76 (87.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlans for subsequent cancer therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (95.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement in case of infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (74.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCondition of chronic diseases (e.g. hypertension) during cancer therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (70.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChanges in regular medications during cancer therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75 (86.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily history of cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (27.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResults of patient\u0026rsquo;s genetic tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (40.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResults of family\u0026rsquo;s genetic tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (28.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient\u0026rsquo;s psychological status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (83.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eCT, computed tomography; CEA, Carcinoembryonic antigen; CA19-9, Carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9; PSA, Prostate specific antigen\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch2\u003eScreening Strategy For Cancer Survivors\u003c/h2\u003e\n \u003cp\u003eWe examined the screening strategy using scenarios concerning a patient with a history of colorectal or prostate cancer (see Supplement 2). The scenario is a hypothetical story about an outpatient with diabetes mellitus and hypertension who underwent surgery for Stage II colorectal cancer (T3N0M0) (Scenario A) or Stage II prostate cancer (T2bN0M0) (Scenario B) two years earlier.\u003c/p\u003e \u003cp\u003eAs seen in Supplemental Table\u0026nbsp;4, around 50% PCPs expected an oncologist to examine survivors of both colorectal and prostate cancer once every six months. Supplemental Table\u0026nbsp;5 shows the \u0026ldquo;additional\u0026rdquo; examination types that PCPs are willing to perform by themselves when any abnormal results are obtained by a fecal occult blood test (Scenario A) or a PSA evaluation (Scenario B) as a regular screening test, including findings for tumor marker evaluations (CEA and CA19-9), abdominal CT, and colonoscopy for the colorectal cancer scenario and a urinalysis, blood tests other than PSA measurement, and abdominal ultrasound for the prostate cancer scenario.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, a multivariable logistic regression analysis revealed that PCPs in clinics were less willing to screen for cancer recurrence than PCPs in academic medical centers or hospitals for both colorectal and prostate cancer scenarios. However, aside from this difference, we noted no significant association between the hypothetical survivor\u0026rsquo;s characteristics in the scenario and the referral behavior among PCPs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between survivor and physician characteristics and referral behavior to an oncologist in vignette-based scenarios regarding screening for cancer recurrence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eScenario A (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eScenario B (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMinimally adjusted model\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOdds ratio (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eOdds ratio (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlder patient age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.94 to 1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.93 to 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor ADL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.14 to 0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.31 to 1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFully adjusted model\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOdds ratio (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eOdds ratio (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlder patient age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.92 to 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.95 to 1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor ADL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.16 to 1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.41 to 3.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysicians\u0026rsquo; gender (Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.26 to 2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.42 to 3.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of physician experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.89 to 1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.88 to 1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of facility (Clinics or others)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.40 to 10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.51 to 12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCI, confidence interval; ADL, activities of daily living; PCP, primary care physician\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eScenario A, colorectal cancer scenario; Scenario B, prostate cancer scenario\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eWe assessed PCP\u0026rsquo;s behavior pattern concerning whether to perform certain examinations before referring the patient to an oncologist on encountering survivors under the given scenarios. We compared the selection of \u0026ldquo;leave all routine screening tests for cancer recurrence to an oncologist\u0026rdquo; and the selection of \u0026ldquo;perform some screening tests before referral to an oncologist\u0026rdquo; as a reference.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePsychosocial support for survivors with anxiety concerning cancer recurrence and difficulty continuing to work after RTW\u003c/b\u003e \u003c/p\u003e \u003cp\u003eScenario C is a hypothetical story concerning an outpatient with hypertension who had no recurrence findings after cancer treatment but was suffering from sleep disturbance due to anxiety about cancer recurrence. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, most PCPs responded that they would set aside time to counsel the survivor in this scenario. In addition, over 40% responded that they would prescribe medication, such as sleep aids, anxiolytics, or antidepressant agents, and around 30% would propose a referral to a psychiatrist or a psychosomatic physician as well as oncologist. Further, more than half of PCPs said they would recommend the patient join a patient advocacy group (PAG).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary care physicians\u0026rsquo; usual attitude towards cancer survivors with anxiety about cancer recurrence (Scenario C) or with difficulty continuing to work after RTW (Scenario D) (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScenario C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScenario D\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSet aside time to counsel patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (88.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribe sleep agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribe anxiolytics or antidepressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefer the survivor to a psychiatrist or psychosomatic physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (32.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvise the survivor to consult an oncologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (39.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEncourage the survivor to join a PAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (25.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvise the survivor to consult a superior at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (59.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvise the survivor to consult an OHP or the occupational health center at their workplace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (75.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvise the survivor to check their work rules regarding changes in work shift or contents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (44.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvise the survivor to take leave from work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (52.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact the survivor\u0026rsquo;s OHP to explain their medical condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e―\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eRTW, return to work; PAG, patient advocacy group; OHP, occupational health physician. Values are summarized as n (%).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eScenario D is another hypothetical story concerning a patient with a similar chronic condition to the one in Scenario C; this patient was experiencing difficulty continuing to perform their work as expected after RTW due to feeling tired during the day. Most PCPs responded that they would set aside time to counsel the survivor in this scenario. In addition, over half responded that they would suggest the patient bring up the matter at their workplace, such as through a consultation with their superior or with an OHP at their workplace, as well as recommend taking a leave of absence from work.\u003c/p\u003e \u003cp\u003eWe were unable to perform multivariable analyses to explore the risk factors that influenced the PCPs\u0026rsquo; perceptions concerning whether to cooperate with or leave matters entirely to other physicians with regard to providing psychosocial support, as most PCPs responded that they would be willing to engage in such support if they were to encounter survivors under the given scenarios.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003e The present study suggested that Japanese PCPs were willing to engage in comprehensive cancer survivor care, regardless of the duration since receiving active cancer treatment. Findings from the vignette-based scenario indicated that PCPs working in clinics were less inclined to conduct screening for recurrence than those working in academic medical centers or hospitals, although we were unable to determine which survivor characteristics more significantly influenced the referral behavior to oncologists. Further, most PCPs were willing to engage in psychosocial support concerning survivors\u0026rsquo; anxiety and work-related issues.\u003c/p\u003e\u003cp\u003eSeveral previous studies have reported that oncologists did not expect cancer survivor care to be performed by PCPs, as PCPs\u0026rsquo; skills and knowledge concerning survivor care were unclear, even when PCPs showed a willingness to engage in such care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Such controversy is considered to reflect poor communication between oncologists and PCPs. However, oncologists might be able to leave various tasks of cancer survivor care to PCPs under expert advice and close cooperation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Indeed, the PCPs in the present study mentioned the need for certain important bits of information for the initiation of survivor care, as has also been reported in previous studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVignette-based studies using hypothetical scenarios representing a particular circumstance are useful for assessing preferences, beliefs, and attitudes of subjects [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Unfortunately, PCPs in Japan have fewer opportunities to engage in collaboration with oncologists than those in other countries. However, using vignettes, we can assess the variations in practice patterns among cancer survivors even if PCPs do not perform such care in their actual clinical practice. Regarding the screening strategy scenarios, PCPs in clinics showed a greater tendency to leave screening tests to oncologists than PCPs in academic medical centers or hospitals. Oncologists might therefore need to consider the resources available to PCPs. Further, an appropriate recommendation or guideline describing the roles that can be performed by PCPs among different types of facilities should be established. Regarding the psychosocial support scenarios, previous studies showed that cancer survivors expected PCPs (rather than oncologists) to provide emotional support [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In particular, encouragement for the improvement of self-efficacy contributed to a higher rate of RTW or continued employment after RTW and a better subsequent quality of life among cancer survivors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The finding from the vignette-based scenario indicated that PCPs were willing to provide psychosocial care to survivors. However, previous studies have recommended the collaboration between PCPs and other healthcare providers, including oncologists, psychiatrists, and OHPs, as PCPs\u0026rsquo; skills and knowledge in this area are unclear [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A future study should explore the perceptions of other healthcare providers concerning the expected role of PCPs.\u003c/p\u003e\u003cp\u003eSeveral limitations to the present study warrant mention. First, the response rate was quite low. Participants in the questionnaire were likely to be concerned with caring for cancer survivors, which might lead to selection bias. Second, in the vignette-based scenarios, we only examined two types of cancer that are relatively common in Japan, which might reduce the generalizability. However, we feel that the results of this study are representative of all cancer survivors and can be applied to patients with other cancer types, except for cancer screening, as patients with colorectal or prostate cancer tend to have a relatively high survival rate and a long remainder of life [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Third, the factors related to the patient characteristics included in the scenario were limited: age and ADL for Scenarios A and B and age, gender, and living style for Scenarios C and D. Finally, the responses given to vignette-based scenario are not always identical to respondents\u0026rsquo; actual practice patterns. However, the findings from this study might highlight the need for further clarification of roles and the establishment of a cooperative framework between PCPs and oncologists for cancer survivor care.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e PCPs in Japan are willing to engage in comprehensive cancer survivor care, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care using PCPs\u0026rsquo; willingness and capabilities. A future study should evaluate the perceptions of oncologists concerning how much survivor care they feel can be left to PCPs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Takuya Aoki, Hidetaka Kawamura, Yujiro Nakayama, Taro Takeshima, and Takashi Yoshioka for their expert advice in developing the scenarios used in the present study. In addition, we sincerely appreciate the cooperation of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by scientific research grants from Japan Primary Care Association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interests for this article. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur manuscripts has data included as electronic supplementary material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using STATA 16.0 (version 16.0; Stata Corp, College Station, TX, USA)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire and methodology for this study was approved by the Kyoto University Graduate School and Faculty of Medicine Ethics Committee (Approval Numbers R1618).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate and/or Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe informed the participants about this study\u0026rsquo;s aim and publishing their data using a cover letter in the introduction section of the questionnaire. We regarded return of the questionnaire as their consent to participate in this study. In addition, we did not include personally identifiable information in our manuscript and electronic supplementary materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data was collected by Miho Kimachi. Data analysis and interpretation were performed by all authors. The first draft of the manuscript was written by Miho Kimachi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMatsuoka Y, Okubo R, Shimizu Y et al (2020) Developing the structure of Japan\u0026rsquo;s cancer survivorship guidelines using an expert panel and modified Delphi method. 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Future Oncol 13(3):233-248\u003c/li\u003e\n\u003cli\u003eDel Giudice ME, Grunfeld E, Harvey BJ, Piliotis E, Verma S (2009) Primary care physicians' views of routine follow-up care of cancer survivors. J Clin Oncol 27(20): 3338-3345\u003c/li\u003e\n\u003cli\u003eCheung WY, Aziz N, Noone AM et al (2013) Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 7(3):343-354\u003c/li\u003e\n\u003cli\u003eMazza D, Mitchell G (2017) Cancer, ageing, multimorbidity and primary care. Eur J Cancer Care (Engl) 26(3)\u003c/li\u003e\n\u003cli\u003eTerret C, Castel-Kremer E, Albrand G, Droz JP (2009) Effects of comorbidity on screening and early diagnosis of cancer in elderly people. Lancet Oncol 10(1):80-87\u003c/li\u003e\n\u003cli\u003eVictoria C, Virginia B (2013) Successful Qualitative Research a practical guide for beginners. London: Sage \u003ca href=\"about:blank\"\u003ehttp://eprints.uwe.ac.uk/21156\u003c/a\u003e. Accessed 12 December 2020\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller-Engelmann M, Krones T, Keller H, Donner-Banzhoff N (2008) Decision making preferences in the medical encounter--a factorial survey design. BMC Health Serv Res 8: 260.\u003c/li\u003e\n\u003cli\u003eBaldwin LM, Triver KF, Matthews B et al (2012) Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations? Ann Intern Med 156(3):182-194\u003c/li\u003e\n\u003cli\u003eHudson SV, Miller SM, Hemler J et al (2012) Adult cancer survivors discuss follow-up in primary care: 'not what i want, but maybe what i need'. Ann Fam Med 10(5):418-427\u003c/li\u003e\n\u003cli\u003eCrabtree BF, Miller WL, Howard J et al (2020) Cancer Survivorship Care Roles for Primary Care Physicians. 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Fam Pract 35(5): 531-541\u003c/li\u003e\n\u003cli\u003eWolvers MDJ, Leensen MCJ, Groeneveld IF, Frings-Dresen MHW, de Boer AGEM (2018) Predictors for earlier return to work of cancer patients. J Cancer Surviv 12(2):169-177\u003c/li\u003e\n\u003cli\u003ede Boer AG, Verbeek JH, Spelten ER et al (2008) Work ability and return-to-work in cancer patients. Br J Cancer 98(8):1342-1347\u003c/li\u003e\n\u003cli\u003ede Kock KA, Steenbeek R, Buijs PC, Lucassen PL, Knottnerus JA, Lagro-Janssen AL (2014) An education programme to increase general practitioners\u0026rsquo; awareness of their patients\u0026rsquo; employment: design of a cluster randomised controlled trial. BMC Fam Pract 15: 28\u003c/li\u003e\n\u003cli\u003ede Kock CA, Lucassen PL, Spinnewijn L et al (2016) How do Dutch GPs address work-related problems? A focus group study. Eur J Gen Pract 22(3):169-175\u003c/li\u003e\n\u003cli\u003eLin JS, Piper MA, Perdue LA et al (2016) Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 315(23):2576-2594\u003c/li\u003e\n\u003cli\u003eProvenzale D, Jasperson K, Ahnen DJ et al; National comprehensive cancer netwok (2015) Colorectal Cancer Screening, Version 1.2015. J Natl Compr Canc Netw 13(8):959-968\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancer survivor, Follow-up care, Oncologist, Primary care physician","lastPublishedDoi":"10.21203/rs.3.rs-161611/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-161611/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eGiven the growing diversity among cancer survivors and the fact that oncologists typically do not perform long-term care, the expected role of primary care physicians (PCPs) in cancer survivor care is expanding. However, communication and collaboration between oncologists and PCPs is lacking. Therefore, we assessed the perception of cancer survivor care among PCPs.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe surveyed 767 Japanese Board-certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs’ perceptions of their role in survivor care. Additionally, we included vignette-based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, \u0026gt;70% of PCPs reported that they were willing to engage in all aspects of survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high-risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40-10.6]) and prostate cancer (4.36 [95% confidence interval 1.51-12.6]) scenarios.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eOur findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated.\u003c/p\u003e","manuscriptTitle":"Primary Care Physicians’ Perceptions Concerning Engagement in Cancer Survivor Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-09 20:09:41","doi":"10.21203/rs.3.rs-161611/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52787220-037b-4f51-8798-3e255686b428","owner":[],"postedDate":"February 9th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":2317943,"name":"Cancer Biology"},{"id":2317944,"name":"Oncology"}],"tags":[],"updatedAt":"2021-12-23T13:27:13+00:00","versionOfRecord":{"articleIdentity":"rs-161611","link":"https://doi.org/10.1002/jgf2.515","journal":{"identity":"journal-of-general-and-family-medicine","isVorOnly":true,"title":"Journal of General and Family Medicine"},"publishedOn":"2021-12-22 13:27:13","publishedOnDateReadable":"December 22nd, 2021"},"versionCreatedAt":"2021-02-09 20:09:41","video":"","vorDoi":"10.1002/jgf2.515","vorDoiUrl":"https://doi.org/10.1002/jgf2.515","workflowStages":[]},"version":"v1","identity":"rs-161611","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-161611","identity":"rs-161611","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}