Study finds high patient satisfaction — and some desire for improvement — during routine oncologic urologic malignancy follow-up visits

A team of researchers at Penn State Health Milton S. Hershey Medical Center’s Department of Urology and Penn State College of Medicine recently published a study to address the gap in knowledge of how their patients with urologic malignancies perceived routine oncologic follow-up visits.¹

Dr. Jay Raman, FACS, interim chair, Department of Urology, head, Robotic Surgery and professor of urology at the Milton S. Hershey Medical Center, and his colleagues conducted the study to determine whether oncologic follow-up exacerbates or alleviates patient stress about recurrence of urologic malignancies. To find out, 337 kidney, prostate and bladder cancer patients completed questionnaires about their feelings during follow-up appointments.

Positive outcomes and room for improvement

The team discovered a majority of patients were satisfied with the strategies physicians provided to combat recurrence anxiety. Patients responded positively to diagnostic testing and reported that receiving these additional tests are not burdensome. Conversely, the patients conveyed an increased sense of anxiety if they did not receive follow-up consultations and testing. The team also learned that patients desired follow-up visits with their urologist rather than their primary care provider, regardless of how far they were required to travel.

“What our study highlighted was that cancer patients like to have diagnostic testing, whether it’s through blood testing or imaging, so they have the reassurance that their cancer is hopefully in remission,” Raman said. “If their cancer has unfortunately returned, they also like to have testing so that they know what they’re dealing with and what the plan will be. One of the huge take-home points from our research is that our patients appreciate follow-up, and they like to see the provider who provided their oncology care.”

However, although the majority of kidney, bladder and prostate cancer patients reported feeling satisfied with the strategies they received to combat fear and anxiety for cancer recurrence, 16% of cancer patients said they desired additional attention, which the researchers suggest is an opportunity for practice improvement.

“When a urologist is providing care to somebody who’s a cancer survivor, it’s sometimes hard to capture all of the elements of survivorship in 15 minutes,” Raman said. “I think that’s one of the gaps that we have, and an improvement that I would suggest is exposing patients to survivorship groups, whether they are offered at an individual hospital or whether they are national groups. Survivorship groups and networks are underutilized but critical.”

Strategies implemented in response to the research

As a result of their research, Hershey Medical Center’s urologists now ask patients if they would like to continue follow-up care in the specialist’s office, instead of returning to a primary care provider.

“We realized that around 90% of our patients prefer to continue to return to our office for follow-up visits,” Raman said. “People grow familiar with their cancer specialists, and for the cancer population, we know that some people will do well, but for other people, their cancer will come back. And when that happens, I think a familiar and trusted face they’ve seen from the start is a really comforting presence for them.”

In addition, support groups provided by hospitals, particularly those that take a whole-person approach, have historically been shown to be critical components of comprehensive cancer treatment.² Taking this information into consideration, along with the study results, the Department of Urology now connects patients with survivorship organizations and on-site resources.

“Exposing these patients to other people who are going through similar experiences, such as a similar diagnosis, side effects or outcome, can positively impact their quality of life,” Raman said.

Funding is also allocated to Penn State Health survivorship groups to support a variety of activities such as invited speakers. However, Raman said the main goal is to make sure patients understand all of their support options, including the Penn State Cancer Institute support groups and Survivorship Program.

Additionally, Penn State Cancer Institute created the new Cancer Assistance and Resource Education (CARE) Center in 2021 to provide physical, emotional, social, spiritual and educational support to help patients navigate through treatment and beyond.

“The CARE Center looks more holistically at patients,” Raman said. “They take into consideration the patient’s emotional and spiritual elements and physical side effects, which all contribute to the survivorship experience. We have individual disease-specific survivorship, but I think the CARE organization, which looks more broadly at all elements of survivorship for cancer patients, is where we need to connect patients.”

The final approach providers are applying in the Department of Urology is an increased effort to help patients take ownership of their overall health and wellness.

“Even if I treat someone for prostate cancer, if their overall health isn’t improved, I probably haven’t done my job right,” Raman said. “Utilizing the CARE Center and trying to get my patients to be a healthier person overall is important. I might not be able to do that in a short visit, but I can get my patients connected to the right resources to live a healthier lifestyle.”

References

1. Sarah A. Strausser et al. Patient Perceptions Regarding Routine Oncologic Follow-Up for Urologic Malignancies. Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2022.01.014.
2. Polley MJ, Jolliffe R, Boxell E, Zollman C, Jackson S, Seers H. Using a Whole Person Approach to Support People With Cancer: A Longitudinal, Mixed-Methods Service Evaluation. Integrative Cancer Therapies. December 2016: 435-445. https://doi.org/10.1177/1534735416632060.