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Survival rates improve if non-cancer problems treated


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http://www.indystar.com/apps/pbcs.dll/a ... e=printart

Caroline Carney Doebbeling is an associate professor of internal medicine and psychiatry at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute.

Question: You recently published a study that showed that lung cancer patients who receive treatment from primary-care doctors for non-cancer-related ailments have higher survival rates than those who do not. What prompted you to look at this?

Answer: I had been working in the Indiana University Cancer Center as a psychiatrist and I'm also a primary-care doctor. Patient after patient after patient who would come to see me was not getting primary care needs addressed with the oncologist. The cancer doctors think, "I'm so busy trying to save this person's life and treat their cancer, I'm not going to treat their cold; that's not what they're here for." That's a mistaken assumption. We did our best to control for factors like age, other co-morbidities and the stage of cancer, and we found that those lung cancer patients who had received primary care visits during the time of their cancer treatment had a survival advantage. Concurrently taking care of primary care problems... things like hypertension, diabetes... seemed to give a survival advantage.

Q: Was it a significant advantage?

A: The survival advantage increased with the number of visits to primary care. We're talking a significant number of months. That's a substantial thing with a disease, especially like lung cancer that has a high mortality with it.

So I think that the message is pretty clear, that we can't forget to take care of the whole person.

I've always been a person who says you want to take care of psychosocial problems while someone is facing a terminal illness. We also need to take care of the rest of their health care. We don't want to save someone from cancer only to have someone die of a heart attack or complications from diabetes.

The second message is the whole idea of taking care of the whole person. Who is really carrying the baton for our patients and should we ever really hand it off? The oncologist is responsible for handling the cancer but no longer is up to speed, so I really think that the role of the primary-care doctor needs to be enhanced in the care of the patient as well.

Q: What's next?

A: We want to repeat this study with national data. We're pretty excited by this. It doesn't matter if we have the best medicine in world or the best screening tools -- if that patient's not being treated, they won't do any good.

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