Bridging the Divide: How Collaboration is Redefining Cancer Care

A significant challenge in modern medicine is the disconnect between oncology and primary care. Historically operating in silos, these essential medical practices often leave patients navigating a complex system where communication gaps can affect the quality of their care.

In an interview, Cheyenne Corbett, PhD, director of the Supportive Care and Survivorship Center for the Duke Cancer Institute and co-director of the Center for Onco-Primary Care, and Nilam Patel, administrative director with both centers, outlined the challenges of this divide and shared a blueprint for collaborative care centered on the patient.

The Challenge of the Silo Mentality

According to Corbett, the main challenge is a necessary "culture shift" in how oncologists and primary care providers (PCPs) view their relationship.

"The oncology and primary care are usually medical practices that are operating in silos, of course, in relationship to patient care," Corbett explained. Historically, once a patient receives a cancer diagnosis, they "enter the cancer care system and then become, typically, a patient of that cancer center, and tends to fall off the radar of the primary care provider."

This often creates an "either or relationship" when what is truly needed is a "both, and" model, where both have "very important roles in the care of patients,” Corbett said.

Patel highlighted the very real consequences of this lack of clarity: "There's just not clarity on whose role it is to take care of the blood pressure or the rising blood sugar... Primary care could assume that, hey, the blood sugar is rising, and that's a result of the treatment, and the oncologist is taking care of it. The oncologist could also assume that this patient has a primary care provider; the primary care provider is going to take care of it."

Corbett added that existing "systems aren't really set up to support that type of seamless communication," which is further complicated by financial models and the fast pace of clinical practice.

A Blueprint for Collaboration: Taking Baby Steps

For oncologists, especially those in community settings without the large infrastructure of an academic center, collaboration with PCPs can be leveraged to provide better patient care. The key, according to Corbett, is a willingness to start small.

"We've had to take baby steps, right? Because it's a culture change for us too," she said. It begins with educating oncologists on how this collaboration can benefit both them and their patients.

For community practices, she suggested:

• Focus on high-need patients: Proactively reach out to the PCPs of patients who have "comorbidity management needs as they're going through treatment."
• Establish a connection: Start connecting with "a couple of primary care provider practices in their area."
• Start small: "Not assuming that it has to be this big, massive change all at once," but rather focusing on "small, identifiable steps."

The "PCP Friendly" Note

One of the most impactful baby steps for the Duke team was addressing communication itself. Corbett’s co-director realized that complicated oncology notes were often "gobbledygook" to PCPs.

"We asked our primary care providers, what is it that you want and need to know that will be helpful for you in taking care of this patient?" Corbett explained.

Patel elaborated on the outcome of this dialogue, which took 6 months of back-and-forth feedback: "We've gotten it down to a single little box that is very clear of who is doing what, and for the primary care provider, what they need to be on the lookout for, as they will have a higher touch point with the patient post treatment."

Corbett added that this shift involved adapting notes so that the information sent to PCPs is in a "PCP-friendly language format," prioritizing "need to know vs nice to know."

Patel stressed that the results of this focused effort extend beyond those directly involved in the conversation. "Once we made that change to the notes, I got feedback from other primary care providers that were not involved in creating that note, giving us kudos for changing it," he said. "Chances are, you talk to a primary care provider and make some improvements. It's going to benefit everyone."

The Critical Takeaway: Patient at the Center

When asked for the most critical feature or action item of the onco-primary care model, both directors returned to the fundamental importance of intentional communication and patient-centricity.

Patel’s succinct advice was: "Make it happen, reach out, talk to—just start with a conversation."

Corbett framed the critical point around the guiding philosophy: "If we put the patient at the center of it, and what does the patient need, and what does quality care look like for the patients, then that drives the oncologist and PCP roles.”

In closing, Corbett encouraged a spirit of continuous learning and experimentation, highlighting that adopting a pilot approach can make difficult conversations easier.

"I think if people approach it in that way, we can really start... making really significant differences in terms of how we care for patients to ensure they get the highest quality care," she said, reminding all clinicians: "Sometimes we forget doing the right thing by our patients means collaborating with somebody down the street, or maybe it means that I'm not the right person to do this."