Table A4.

Primary Care Providers' Comments on Survivorship Consultations

Themes	Sample Quotes
Having an expert oncologist is important	“Oh, I think [having an oncologist] is absolutely essential to me, that's really the added value to this. … I think the key to this, for us as physicians, is— this is really a new area. People in the past have not really thought about how you take care of a survivor and so it's not protocolized. There's a lot of new information all the time so it's not really something that I think can be sort of routinely done.” “I'm a general internist … the type of patient that I would send there, I would really expect to get an oncologist's opinion, because by definition, that would be somebody complicated.” “It's important … because what I care about is the clinical synthesis, thankfully. I probably wouldn't send them over if there wasn't a doctor.”
An expert oncologist is particularly critical in complex cases	“In the case of my patient it's different from some more common malignancies like breast and colon cancer, where I would have a pretty good idea of what the regular follow up routine would be. With leukemia and diseases like that you need someone who knows how to stay on top of what needs to be done.” “I think that at a tertiary medical center like here, where I see patients maybe a little bit more complicated … it's important that maybe an expert oncologist see it.” “It can be stratified for certain illnesses. Maybe breast cancer can be some of the more standard illnesses, but childhood illnesses are a little more different; treatment plans can change quite a bit over the last several years.”
Hesitations about accepting recommendations written solely by a nurse practitioner	“Within a survivorship program, you could certainly have different providers for different tracks … You certainly could have a well-trained nurse practitioner who could give you the plan for a 65-yr-old woman who had a stage I breast cancer … I think where having the oncology oversight is so important … is in these more complicated cases, where patients have received multiple types of chemotherapy and there may be uncertainty or disagreement on what the follow-up should be.” “The other risk that I have seen working with some nurse practitioners … is again this whole issues that for us as primary care doctors, you better have the evidence for things that you recommend that cost money. If you say that this patient needs a breast MRI, you better have a good reason that I can give her insurance company because if you don't, then the patient's pissed off, I'm pissed off; it's just not going to work.”