Reply to E. Zanet et al
Authors: Danielle Blanch-Hartigan, Larissa Nekhlyudov, Tenbroeck Smith, Catherine M. Alfano, Julia H. Rowland, Laura P. Forsythe, Patricia A. Ganz
Journal: Journal of Clinical Oncology (2014)

We appreciate Zanet et al's 1 consideration of our research and commend their efforts to advance survivorship care in Italian practice.As they describe, the proposed Cancer Survivor Clinics (CSCs) aim to coordinate survivorship care and promote knowledge of survivors' needs, two approaches our results suggest may engage survivors and improve care. 1 Many major academic cancer centers in the United States have implemented comprehensive survivorship clinics with similar goals to the CSCs described.As the authors acknowledge in their response 1 and others have pointed out, 2 there are major barriers to the widespread implementation of this model in the US system, including lack of a unified reimbursement method and the fact that, in many geographic areas, the number of cancer survivors may be too few to warrant even community-based survivorship clinics.Further, most cancer survivors in the United States are not cared for in academic medical centers but receive their care from community-based primary care providers (PCPs). 3Survivors vary in terms of risk for long-term effects and recurrence, and those at lower risk may not require specialty care; this is reflected in emerging efforts to develop risk stratification protocols for survivor care. 4he Survey of Physicians' Attitudes Regarding the Care of Cancer Survivors (SPARCCS) provided novel insight into PCPs' practices and preferences for survivorship care.Our result demonstrating that PCPs receiving a survivorship care plan (SCP) are more likely to engage in survivorship care discussions with patients is unique and provides important evidence of the utility of SCP. 5 SPARCCS findings also suggest that PCPs feel they can provide, and in many cases already see themselves as providing, follow-up care for survivors. 6However, PCPs may benefit from training in long-term and late effects and guidance on appropriate care standards 7 ; receipt of SCPs might also help PCPs in these areas.The expressed need of PCPs for information and their key role in ongoing medical care, particularly for older survivors, is in part why the American Cancer Society chose to direct their newly released SCPs to PCPs. 8 Efforts to educate, train, and disseminate good survivorship care through PCPs can improve care.We would like to clarify one point made by Zanet et al 1 who implied that PCPs rarely release SCPs.Our results did not report on the provision of written SCPs by PCPs, given that PCPs are typically not tasked with generating these documents. 5Rather, SPARCCS estimates showed that approximately 10% of oncologists reported regularly providing SCPs, and 13% of PCPs reported regularly receiving them. 5,9 The SPARCCS survey and our results were not intended to compare different models of care, and thus we cannot comment on an ideal model of survivorship care.In the United States, we will likely need multiple models of care to meet the various needs and preferences of survivors and providers.The ideal model of survivorship care and the degree of involvement of PCPs will likely vary based on factors such as individual risk profiles, different hospital systems, rural versus urban environments, and type of cancer. 10What is clear is that there is a great need for future research to evaluate models of care, focusing on finding those that are effective, efficacious, and sustainable.Data from the SPARCCS survey, including our own findings, provide useful insights into and nationally representative benchmarks of PCP and oncologist knowledge, attitudes, and practices in the area of survivorship care.