SHARED MANAGEMENT OF CHILDREN WITH CANCER

Objective: To determine the risks and benefits of university-based ped iatric oncologists and community-based primary care physicians sharing the management of children with cancer. Design: Physicians participat ing in shared management of children with cancer were surveyed, and th e outcomes of the children were measured. Setting and Participants: On e hundred thirty-seven community-based primary care physicians partici pated in the management of the 226 children with cancer in Iowa and we stern Illinois during the past 15 years. The survival of the 226 child ren was compared with that of 240 randomly selected children treated u sing the identical treatment protocols but treated only by pediatric o ncologists. Intervention: A 7-point Likert scale questionnaire was com pleted by 97 (71%) of the participating primary care physicians. Resul ts and Outcome Measures: There were no differences in the survival of children using shared management compared with those treated only by p ediatric oncologists. Primary care physicians believed that shared man agement is of economic and psychosocial benefit to patients, improves the treatment choices available to patients, does not require excessiv e time, and does not result in loss of practice income. The system str engthens the primary care physicians' relationships with oncologists a nd results in additional referrals to the university-based pediatric o ncologists. It is of educational value, is personally satisfying, and provides relief from the stress associated with caring for these famil ies. Primary care physicians would like to see this system expanded to include other children with special health care needs. Conclusion: Th e shared-management approach to care is a viable, attractive option of health care provision for children.