Abstract B20: Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives
Authors: Rutledge Teresa , Kano Miria , Guest Dolores , Sussman Andrew , Kinney Anita 
Published: March 2017

Abstract
BACKGROUND
The number of women diagnosed with gynecologic cancers in the U.S. is increasing rapidly. The American Society of Clinical Oncology predicts a 48% increase in the number of people developing cancer by the year 2020. Yet the numbers of oncologists and available services are rising much more slowly; data indicates an increase in the workforce of only 14% by 2020. This workforce shortage may lead to challenging conditions for optimal survivorship care, particularly in rural and other underserved areas. Although endometrial cancer survivors (EC) often receive favorable prognoses, they remain vulnerable as many suffer health challenges due to comorbidities that can be more life threatening than the cancer itself. Adequate treatment for these comorbid conditions requires regular clinician oversight, yet many rural EC survivors travel hours for follow-up care in oncology settings, and comorbidities are often unaddressed. Although transition from oncology specialty care to primary care seems an obvious solution, acceptance of this transition by EC survivors and primary care providers (PCPs) has not been well studied.
METHODS
We conducted a qualitative study with 53 EC survivors and 16 PCPs to identify barriers and facilitators to optimal EC survivorship care. Between October 2014 and September 2015, we conducted 9 focus groups with EC survivors in rural and urban communities, and 3 focus groups with PCPs from across New Mexico. Focus groups were designed to elicit information specific to routine cancer follow-up care from patient and provider perspectives as well as to ascertain patient willingness to, and provider readiness for, transition of EC survivors from oncology clinics to primary care practices for post-treatment cancer care. Focus groups were digitally recorded and iteratively reviewed for development of initial coding structures. The transcripts were reviewed by the research team and a thematic analysis was performed. Transcripts were imported into NVivo 10, a qualitative data analysis program, for final coding and data analysis.
RESULTS
Twenty-one (40%) of the EC survivor participants were Hispanic origin and 55% resided in rural communities. 37.5% of the provider participants served rural regions. EC survivors expressed high levels of satisfaction with their oncology care and suggested that transitioning to PCPs for follow-up care would be convenient yet challenging. Challenges cited include: 1) patient perceptions of deficits in PCP's understandings of cancer surveillance; 2) inability to identify a personal PCP; and 3) lack of communication between oncologists and PCPs. PCP participants similarly identified the need for more extensive EC training and more effective communication strategies with oncologists as necessary factors for accepting responsibility for EC follow-up care. Both EC patients and PCPs offered strategies to improve the coordination of care and create a more team based approach to EC survivorship care. Strategies discussed include: 1) develop survivorship care plans to improve communication for both patients and provides; 2) ensure easy access back to oncologist; and 3) provide supportive care services.
CONCLUSIONS
The transition from cancer treatment to cancer survivor care is a complex time for the patient. Increasing the role of the PCP in the ongoing care of EC survivors was generally considered acceptable by both patients and providers in both rural and urban women. Findings from our study did inform strategies to facilitate this transition. Successful coordination of care between cancer survivors, oncologists and PCPs will be a critical step in improving the cancer care delivery of our rural patient and provider population.
Citation Format: Teresa Rutledge, Miria Kano, Dolores Guest, Andrew Sussman, Anita Kinney. Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B20.