Who Is Going to Quarterback Survivorship Care? Bhavana Bhatnagar, DO

As cancer treatments improve and more patients live longer after diagnosis, one of oncology’s most persistent problems remains unsolved: nobody has fully figured out who is responsible for a patient’s care once active treatment ends. That is the assessment from Bhavana Bhatnagar, DO, associate professor of medicine at West Virginia University Cancer Institute at Wheeling Hospital, who says survivorship care is “increasingly important, but also uniformly difficult to execute,” even at major academic medical centers.

Part of the difficulty starts with definitions. Survivorship, Bhatnagar explains, has recently been redefined to cover the entire span “from the time of diagnosis to whatever happens,” not simply the period after treatment ends. This broader scope has exposed gaps in coordination, particularly around who should manage a patient’s care long after active treatment: the oncology team, primary care, or some combination of both.

Formal care plans that once outlined follow-up steps to catch late toxicities have largely fallen out of use, and even when they existed, Bhatnagar says adherence was inconsistent. The result, in her view, is that patients often feel abandoned once the intensity of treatment ends.

“They often feel kind of homeless, for lack of a better term; they’re not seeing their oncologist as often, but they are still experiencing either psychological, mental, physical, or emotional effects of the cancer therapy itself,” she said in a recent interview with The American Journal of Managed Care^®.

That unmet need shows up directly in her clinic. “I certainly see patients who are not actively on therapy but have gone through chemotherapy, and sometimes those visits are the longest, even though we’re not talking about anything pertaining to the actual cancer,” Bhatnagar noted, adding that she is not formally trained to address many of the lingering effects patients raise and is often uncertain where to refer them.

Robust survivorship programs do exist at some institutions, she said, but needs vary widely from patient to patient—some carry lifelong physical adverse effects (AEs), while others struggle primarily with emotional and psychological AEs. Bhatnagar expects the issue to intensify as treatment advances extend survival. Patients are living longer, she said, but “they’re not without their war wounds, and we have to address those, too.”