Primary Care's Perception of Role in Thyroid Cancer Survivorship Care

July 15, 2020

New research is defining how primary care providers view their role in long-term survivorship care of patients with thyroid cancer.

A new study from the University of Michigan is providing clinicians with a more accurate overview of the level of involvement primary care providers have in thyroid cancer survivorship care.

Performed in an effort to develop a greater understanding of primary care involvement and confidence in thyroid cancer survivorship care, results offer clinicians greater insight into the potential role of primary care providers after surviving thyroid cancer.

“Our findings expand on prior cancer survivorship literature by characterizing PCP involvement in caring for thyroid cancer survivors. Delivering high-quality, coordinated cancer survivorship care has been challenging In general, there remains a lack of clarity and guidance around which provider—cancer specialist or PCP—handles cancer survivorship care,” investigators wrote.

With data indicating rates of thyroid cancer diagnoses have more than tripled in the past 5 decades and a shortage of endocrinologists, investigators hoped to assess the involvement and confidence of primary care providers in the care of patients who survive thyroid cancer. Investigators also note previous research suggests more than half of primary care providers surveyed support a more collaborative approach to care with cancer specialists.

As part of the Georgia and Los Angeles Surveillance, Epidemiology and End Results (SEER) registries, participants were asked to identify a doctor most involved in their treatment decision making other than their surgeon or endocrinologist. Using the clinicians identified, investigators obtained a cohort of primary care providers as possible participants in their study.

After sending surveys to the aforementioned group of clinicians, investigators received responses from a total of 162 primary care providers. The main goals of the survey were to assess primary care providers’ involvement in long-term surveillance and the primary care providers’ confidence in handling thyroid cancer survivorship care.

Of note, investigators pointed out additional measures were added to the survey to assess attitudes and beliefs of primary care providers in regard to their role in thyroid cancer survivorship care.

Upon analysis, investigators found most of the respondents (76%) reported being involved in long-term surveillance. Among those who reported involvements, clinical guidelines were cited as the most influential source in guiding treatment (OR, 4.29; 95% CI, 1.56-11.82).

When examining primary care providers reporting high confidence in handling long-term survivorship care varied depending on the situation examined. Specifically, 39% reported confidence in referring patients to a specialist, 36% reported confidence in understanding the role of neck ultrasound, 27% reported confidence when assessing random thyroglobulin levels, and 14% reported confidence in knowing when to end long-term surveillance.

Additionally, investigators pointed out primary care providers reporting involvement were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs 7.9%; P <.01).

“While PCPs reported being involved in long-term surveillance, gaps remain in their confidence in handling survivorship care. Thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation,” investigators wrote in their conclusion.

Investigators pointed out there were multiple limitations with their study. Limitations within the study included a small sample size, the cross-sectional nature limits conclusion regarding temporality and causality, and lack of information surrounding parameters of the survivorship period.

This study, “Primary care provider involvement in thyroid cancer survivorship care,” was published in The Journal of Clinical Endocrinology and Metabolism.