Characterizing the relationships between tertiary and community cancer providers: Results from a survey of medical oncologists in Southern California

• Published in: Cancer medicine (Malden, MA) MA), 2021-08, Vol.10 (16), p.5671-5680
• Main Authors: Salgia, Nicholas J., Chehrazi‐Raffle, Alexander, Hsu, JoAnn, Zengin, Zeynep, Salgia, Sabrina, Chawla, Neal S., Meza, Luis, Malhotra, Jasnoor, Dizman, Nazli, Muddasani, Ramya, Ruel, Nora, Cianfrocca, Mary, Gong, Jun, Anand, Sidharth, Chiu, Victor, Yeh, James, Pal, Sumanta K.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; California; Cancer; Cancer Care Facilities - organization & administration; Cancer Care Facilities - statistics & numerical data; Cancer Prevention; Clinical medicine; Clinical trials; Clinical Trials as Topic; Communication; community oncology; Demographics; Demography; Female; Hospitals; Hospitals, Community - organization & administration; Hospitals, Community - statistics & numerical data; Humans; Integration; Intersectoral Collaboration; Male; Medical referrals; Middle Aged; Neoplasms - diagnosis; Neoplasms - therapy; Oncologists - statistics & numerical data; Oncology; Patients; Precision medicine; Referral and Consultation - organization & administration; Referral and Consultation - statistics & numerical data; referrals; Surveys and Questionnaires - statistics & numerical data; tertiary cancer center; Tertiary Care Centers - organization & administration; Tertiary Care Centers - statistics & numerical data
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4119

Background Tertiary cancer centers offer clinical expertise and multi‐modal approaches to treatment alongside the integration of research protocols. Nevertheless, most patients receive their cancer care at community practices. A better understanding of the relationships between tertiary and community practice environments may enhance collaborations and advance patient care. Methods A 31‐item survey was distributed to community and tertiary oncologists in Southern California using REDCap. Survey questions assessed the following attributes: demographics and features of clinical practice, referral patterns, availability and knowledge of clinical trials and precision medicine, strategies for knowledge acquisition, and integration of community and tertiary practices. Results The survey was distributed to 98 oncologists, 85 (87%) of whom completed it. In total, 52 (61%) respondents were community practitioners and 33 (38%) were tertiary oncologists. A majority (56%) of community oncologists defined themselves as general oncologists, whereas almost all (97%) tertiary oncologists reported a subspecialty. Clinical trial availability was the most common reason for patient referrals to tertiary centers (73%). The most frequent barrier to tertiary referral was financial considerations (59%). Clinical trials were offered by 97% of tertiary practitioners compared to 67% of community oncologists (p = 0.001). Most oncologists (82%) reported only a minimal‐to‐moderate understanding of clinical trials available at regional tertiary centers. Conclusions Community oncologists refer patients to tertiary centers primarily with the intent of clinical trial enrollment; however, significant gaps exist in their knowledge of trial availability. Our results identify the need for enhanced communication and collaboration between community and tertiary providers to expand patients’ access to clinical trials. Further relationships between community and tertiary medical oncologists are imperative to increasing clinical trial enrollment and successful patient outcomes. This study reports significant gaps in the knowledge of clinical trial availability among oncologists and identifies a need for increased communication and collaboration between the practice settings.