The cancer care survey involved more than 65,000 patients who had been treated in 1999 and 2000. Cancer care in England has recently been organized into 172 networks or “Trusts.” Data from the survey were made available to each Trust so they could compare their results with other care providers. The position of “Primary Care Cancer Lead Clinician” has been created as part of this reorganization to improve communication between primary and specialty care providers, raise awareness of cancer in primary care, and improve palliative care (Leese et al., 2004).

Several clinical trials have been conducted in Europe to assess alternative models of survivorship care. A shared cancer care program implemented and tested as part of a clinical trial had a positive effect on patients’ evaluation of cooperation between the primary care providers and specialists (Nielsen et al., 2003).

The trial involved patients with several types of cancer seen in a Danish university hospital-based practice. The intervention involved knowledge transfer, communication channels, and active patient involvement (Box 4C-1). The shared care program increased contacts with the general practitioner and did not adversely effect quality of life.

A commentary that accompanied the publication of this trial emphasized the importance of the involvement of both patients and providers in formal shared-care arrangements in cancer (Maher and Millar, 2003). In

BOX 4C-1
Components of Shared-Care Program Tested in a Clinical Trial

Knowledge transfer

  • Discharge summary letters following predefined guidelines

  • Specific information on the disease and its treatment

  • General information about chemotherapy and radiotherapy

  • General information about pain treatment

  • Information about treatment of induced nausea and sickness

  • Information about some acute oncologic conditions

Communication channels

  • Names and phone numbers of doctors and nurses responsible for the patient were attached to the discharge summary letter to the general practitioner (GP)

Active patient involvement

  • In the intervention group the patients received oral as well as written information about the information package to their GP

  • The patients were encouraged to contact their GP when facing problems they assumed could be solved in this setting

SOURCE: Nielsen et al. (2003).

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