Family Medicine Physician Understanding and Management of HNC Survivorship Care

Introduction: American Head and Neck Society (AHNS) head and neck cancer (HNC) survivorship guidelines highlight primary care physicians (PCPs) as key in survivorship care. However, HNC is an uncommon disease that PCPs manage less frequently. Thus, we characterized family medicine (FM) physicians’ and trainees’ understanding of HNC survivorship care.

Methods: Cross-sectional survey regarding FM provider awareness of HNC survivorship guidelines. Survey was distributed to FM mailing lists and national forums. Descriptive statistics were used to characterize responses.

Results: 86-physician cohort of majority attending physicians (86.1%) with an average of 20.0 years in practice working in non-rural (75.6%), outpatient community medical centers (41.9%). Respondents rarely cared for HNC survivors - 4.9% of patients per provider on average. They were largely unaware of the updated AHNS guidelines (8.1%). Physicians were least aware of the importance of discussing sexual intimacy/dysfunction (70.9%) and HPV vaccination among HPV+ HNC patients (50.0%). Physicians were generally aware of cardiovascular disease’s impact on mortality risk (64.0%) and higher prevalence of lung cancer (60.5%) among HNC patients but were less aware of their increased risk of depression (45.4%) and suicide (39.5%). On a five-point Likert scale, physicians endorsed high confidence in counseling about substance use cessation (Avg 3.67) and screening for thyroid dysfunction (Avg 3.65) and low confidence in managing long-term effects of chemotherapy (Avg 1.48), radiotherapy (Avg 1.48), and surgery (Avg 1.47). Physicians endorsed moderate overall confidence in managing HNC patients (Avg 2.38).

Conclusions: FM physicians are critical to HNC survivorship care but are lacking the knowledge and exposure to best care for this patient population. FM physicians would benefit from additional education and training on this disease and demographic.