Enhancing collaboration between primary care physicians and oncology specialists—through cancer prevention, screening, detection, therapy, survivorship, and end-of-life—supports improved patient outcomes. This is so compelling that Duke Cancer Institute (DCI) founded a first-of-its-kind Center for Onco-Primary Care, directed by renowned cancer survivorship expert Kevin Charles Oeffinger, MD. 

“We’re building relationships and initiatives to get patients to the right place at the right time, which leads to better outcomes,” says Oeffinger. “We’ve engaged our Duke Primary Care network of 400 providers across 44 clinic sites and primary care groups.” 

The Center’s mission is three-fold: 

• Deliver evidence-based, patient-centered, personalized health care across the cancer continuum by improving collaboration between cancer specialists and primary care clinicians
• Conduct innovative research with cutting-edge technology that can be translated into the community
• Train and educate the next generation of clinicians and researchers 

“You won’t find another cancer center doing what we’re doing—in fact, other centers are leaning on us to help them scale programs for their facilities,” Cheyenne Corbett, PhD, co-director of the Center for Onco-Primary Care.

Cancer outcomes improve when primary care clinicians are more involved in clinical decision-making, such as implementing prevention strategies, identifying patients at risk for cancer, and guiding patients to appropriate screening measures to improve early detection. 

Primary care providers are also essential in managing comorbidities during and following cancer treatment, such as hypertension, diabetes, obesity, and cardiovascular disease. Optimal management of non-cancer-related comorbidities reduces emergency department visits and hospital admissions, leading to better long-term outcomes. 

“When we properly risk-stratify patients during survivorship, those with high long-term risks of reoccurrence may be followed by their oncology team, while lower-risk groups are followed by their PCP,” says Oeffinger. “Our goal is to get PCPs thinking about the care of patients in the context of cancer across the lifespan, and for oncology providers to think about cancer in the context of patients’ broader health,” adds Corbett.

The Center for Onco-Primary Care prioritizes its interventions with three approaches: classic research, quality improvement, and training or education. 

One example is the National Institutes of Health (NIH)-funded ONE TEAM study, which applies a multi-level intervention with patient and PCP strategies to optimize the management of cardiovascular disease comorbidities of men with prostate cancer during and after cancer therapy. 

“We developed a ‘low-touch’ intervention by enhancing systems and tools primary care providers are already using,” says Oeffinger. “We adapted the electronic health record to automate a cancer specialist-to-PCP letter, deliver a tele-education series, and send reminders to nudge following up with patients who have cardiovascular disease risks.” 

Another intervention involved prostate cancer screening. In 2017, members of the Duke Prostate Cancer Task Force recognized there was an increased number of men presenting with advanced-stage prostate cancer due to a lack of screening, and this group represented a disparate number of Black men. The Center developed a novel, evidence-based prostate cancer screening guideline for Duke University Health System. 

By implementing the guidelines in the EHR’s PCP health maintenance section, Duke’s screening rates increased from 49% to 68% within a year. Over time, a more aggressive screening program led to an increase in referrals to Duke urologists, especially of men with modestly elevated PSAs. However, this higher volume extended the time from a PCP’s referral to an appointment with a urologist to over 120 days. 

“To solve this problem, we implemented a virtual elevated PSA clinic (ePSA) for men with a modestly elevated PSA of less than 10 to fast-track the men with a PSA of 10 or higher to a Duke urologist. The ePSA clinic is staffed by our onco-primary care APPs, who are trained to evaluate patients with elevated PSAs, order additional blood tests, and if indicated, prostate MRIs and/or biopsies,” explains Oeffinger.

The APPs staffing the virtual ePSA clinic have seen over 1,200 patients, of which 15% were diagnosed with high-grade prostate cancer. 

The Center is committed to several other interventions, including:

• Employing onco-primary care APPs at two Duke Primary Care clinic locations to help patients transition care to their primary care provider after cancer therapy
• A program that embeds endocrinologists in oncology care teams to properly treat patients with hyperglycemia undergoing cancer therapy 
• Survivorship programs designed for younger adult populations with cancer

Oeffinger says, “We don’t want the health system to fail our patients at any point. We’re passionate about maximizing provider relationships, processes, and systems to deliver better care.”