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Pioneering Program Links Providers Throughout Patients’ Cancer Treatment

Primary care physicians, oncologists coordinate care to manage comorbidities

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From the moment a patient is informed that a cancer screening test is positive, the patient’s care team is often so focused on treating the cancer that red flags such as high cholesterol, glucose, and blood pressure levels are overlooked unless they’re critically high. But these comorbidities could be the eventual cause of fatal conditions.

The Duke Cancer Institute (DCI) Center for Onco-Primary Care formally links primary care physicians (PCPs) and oncologists in the care of patients before, during, and after active cancer treatment, ensuring that potential comorbidities are properly managed along with the patient’s cancer.

“What we’ve come to realize is that many patients who are treated for cancers with high cure rates—breast, colorectal, endometrial, early-stage lung, prostate—will often have a cardiac event or stroke five to 10 years after successful cancer treatment. And it’s not related to what we did, but to what we didn’t do,” says Kevin C. Oeffinger, MD, a family medicine physician who is the founding director of the Center for Onco-Primary Care and director of the DCI’s Supportive Care and Survivorship Center.

One example Oeffinger uses to illustrate the importance of this collaboration is a patient who was undergoing treatment for chronic lymphocytic leukemia (CLL). The patient also had hypertension, which was well controlled with three medications.

“After the patient was started on ibrutinib his blood pressure began to gradually increase,” says Oeffinger. “We knew his risk for developing a complication that would limit his ability to continue the cancer drug was growing.” The Center’s staff linked the patient’s PCP with the oncology team to explain target blood pressure levels with ibrutinib and recommend immediate changes to his hypertension treatment plan.

“This is what primary care physicians are asking for,” says Oeffinger. “’Tell me what I need to know, what I need to watch out for, when I need to avoid certain agents—and tell me explicitly.’ In this patient’s case, the message from the primary care physician back to the oncology team was: ‘Got it, I’m on it.’ That’s exactly what we’re trying to accomplish; it would have been tragic if we had prevented this patient’s death from CLL only to lose him to a preventable heart attack.”

New tools and technologies are important parts of the Center’s effort to scale up ongoing efforts to include more community-based providers and conduct nationwide clinical trials, Oeffinger reports.

For example, an automated blood pressure cuff that will instantly transmit readings to the patients’ EHR for follow-up by the patient’s oncology and primary care teams is the subject of an upcoming trial. Research is also expected to begin soon on a survivorship care model. Oeffinger says the hope for this research is not only to make PCPs active team members during a patient’s cancer therapy, but also to help them become more familiar with the patient’s long-term needs. “We think this will greatly enhance the transition of patients from cancer care to primary care once the risk of cancer recurrence is reduced.”

Oeffinger credits a team of oncology and primary care specialists in supporting the Center and filling integral roles for its growth, including: Cheyenne Corbett, PhD; John Anderson, MD; Danielle Brander, MD; Susan Dent, MD; Michaela Dinan, PhD; Daniel George, MD; Rachel Greenup, MD, MPH; Michael Harrison, MD; Steven Patierno, PhD; John Ragsdale, MD; Kevin Shah, MD; Anthony Sung, MD; Andrea Sitlinger, MD; Yousuf Zafar, MD, MHS; and Leah Zullig, PhD.