Family Medicine Physician Understanding and Management of Head and Neck Cancer Survivorship Care: A National Assessment.

Abstract

Objectives: To understand United States family medicine physicians' and trainees' awareness, understanding, and confidence in following HNC survivorship guidelines.

Methods: Cross-sectional survey regarding FM provider awareness of HNC survivorship guidelines. The survey was distributed to FM mailing lists and national forums. Descriptive statistics were used to characterize responses.

Results: Eighty-six-physician cohort of majority attending physicians (86.1%) reporting an average of 20.0 years in practice working in non-rural (75.6%) outpatient community medical centers (41.9%). Respondents rarely cared for HNC survivors - 4.9% of patients per provider on average. They were largely unaware of the updated AHNS guidelines (8.1%). Physicians were least aware of the importance of discussing sexual intimacy/dysfunction (29%), considering pituitary dysfunction among patients with prior skull base radiation (29.1%), and evaluating for thyroid dysfunction (54.65%). Physicians were generally aware of cardiovascular disease's impact on mortality risk (64.0%) and higher prevalence of lung cancer (60.5%) among HNC patients but were less aware of their increased risk of depression (45.4%) and suicide (39.5%). On a 5-point Likert scale, physicians endorsed high confidence in counseling about substance use cessation (mean = 3.67), screening for thyroid dysfunction (mean = 3.65), and low confidence in managing long-term effects of chemotherapy (mean = 1.48), radiotherapy (mean = 1.48), and surgery (mean = 1.47). Physicians endorsed moderate overall confidence in managing HNC patients (mean = 2.38).

Conclusions: FM physicians are critical to HNC survivorship care but have a variable understanding of HNC survivorship guidelines. Increasing FM physicians' awareness and understanding of survivorship care will help to continue improvement in HNC survivors' quality of care and life.