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The optimal system for the delivery of high-quality, well-coordinated survivorship care is still controversial, and various models have been suggested in the United States and other countries, including exclusive follow-up care by primary care physicians (PCPs), shared care with PCPs or nurse practitioners, and specialized multidisciplinary survivorship programs.[1]

Recently, an Italian group of researchers suggested developing cancer survivorship clinics within the departments of oncology at major cancer hospitals with medical oncologists and psychologists working together in association with other specialists, particularly cardiologists.[2, 3] Such a model was based on the assumption that patients are reluctant to have their care be transferred to general practitioners, and general practitioners have a low level of interest in managing the care of patients with cancer.[2] Barriers to implementing survivorship care plans were also considered.[4]

The best model of care delivery may depend on various factors, such as the health care delivery system, physician supply, reimbursement policy, geographic conditions, health information technology, and various cultural aspects such as the health beliefs of the general public. Therefore, no single model would fit every situation.[5] We believe sharing our experience in Korea would be of help in some cases.

In Korea, where people are densely populated in a small country, patients often travel to highly specialized cancer centers for treatment.[6] The average oncology consultation time is only approximately 7.1 minutes,[7] and oncologists often underestimate or fail to identify various patient needs.[8]

In a qualitative study, Korean oncologists often reported difficulty in delivering preventive or primary care to cancer survivors by themselves due to short consultation times and limited knowledge.[9] Moreover, they did not consider such tasks to be their responsibility, although they believed that many long-term survivors expect them to treat all health problems. Many oncologists generally agree with the idea of shared care with PCPs who can provide preventive care, vaccination, chronic disease management, and screening for second primary cancers. However, at the same time, they expressed concern regarding sharing the care with PCPs in community clinics because of the difficulties involved in the exchange of medical information between the cancer center and community clinics.

As a result, an institution-based shared-care model, involving family physicians or general internists within the cancer center, was suggested as a preferred solution for the following reasons: easy sharing of information by electronic medical record, easy communication between oncologists and PCPs, and patients' general preference for being cared for at the same institution in which they received treatment.[9]

During the last 2 years, cancer survivorship clinics have been established in several major cancer centers in Korea. Although most oncologists are still unfamiliar with these clinics, some have begun to recognize the need for shared care and to transfer their long-term survivors to these clinics. Many patients who were initially reluctant to be transferred to these clinics subsequently reported satisfaction in that they can receive more comprehensive care for their health, in addition to needed follow-up for their primary cancer. They also felt safe because they can have direct access to their original oncologists in case they had any oncologic complications, such as disease recurrence. A cancer survivorship research group has been formed under the Korean Academy of Family Medicine, and recently published a practice guide for PCPs regarding the care of cancer survivors and their families.[10]

Currently, the concept of an “integrative supportive cancer survivorship center,” which is wider in scope than institutional shared care, is being developed.[11] Professionals in psychooncology, rehabilitation, pain control, and nutritional management as well as social workers are involved in these centers, and the care is coordinated by the PCPs. With technological and legal progress being made in the exchange of medical information, community-based shared care may also become a viable strategy for long-term survivorship care.

FUNDING SUPPORT

No specific funding was disclosed.

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

  • Dong Wook Shin, MD, DrPH, MBA

  • Department of Family Medicine

  • and Cancer Survivorship Clinic

  • Seoul National University Hospital

  • Seoul, Republic of Korea

  • Jong Hyock Park, MD, MPH, PhD

  • Division of Cancer Policy and Management

  • National Cancer Control Institute

  • National Cancer Center

  • Goyang, Republic of Korea

  • College of Medicine/Graduate School of Health Science Business Convergence

  • Chungbuk National University

  • Cheongju, Korea

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