Oncologists’ management of non-cancer conditions: An observational study.

23 Background: Cancer diagnoses introduce layers of complexity for care coordination. Oncologists often find themselves independently managing coincident, non-cancer illnesses. How often oncologists engage in direct management of non-cancer conditions, rather than coordinating with patients' other providers, is not well understood. We examined how often oncologists prescribe medications to manage non-oncologic conditions, as a proxy for assuming primary-care responsibilities. Methods: The cohort included all US physicians with a specialty of Hematology-Oncology or Medical Oncology from 2016-2020, available in the Centers for Medicare & Medicaid Services Part D Prescribers dataset. Prescription drugs were categorized as “cancer-directed”, “cancer-related” (eg., opioid pain medications), or “non-cancer” (eg., antihypertensives). Primary outcomes included prescription of cancer-directed, non-cancer, and cancer-related medications. Multivariate logistic regression assessed the association between non-cancer medication prescriptions and provider location, medical school graduation year, gender, and practice affiliation during 2020. Results: A mean of 8.3% (median 5.3%, IQR 0% – 12.5%) of oncologists’ prescriptions were for non-cancer medications; this decreased during the study period, falling from 9.5% in 2016 to 7.4% in 2020 (p<0.001 on Kruskal Wallis test for non-parametric data). Providers practicing in the Midwest (aOR 1.3, 95%CI [1.2-1.5]), Southeast (1.5 [1.3-1.7]), and Southwest (1.6 [1.4-1.9]) were more to prescribe non-cancer medications, as were providers who graduated >10 years prior to the end of the study period, most notable in providers graduating 1990–1991 (2.2 [1.9-2.6]). Those at academic institutions (0.7 [0.6-0.8]) were less likely to prescribe non-cancer medications. Conclusions: A small but substantive portion of oncologists’ prescriptions are for medications unrelated to cancer care. The downtrend in non-cancer prescriptions may reflect that coordinated co-management of patients with cancer is increasing. The rise in telemedicine and digital health represents an opportunity to establish stronger multidisciplinary care for patients with cancer through hybrid cross-collaboration between primary care physicians and oncologists. This is especially advantageous in regions where in-person integration of physician groups may not be possible. Additionally virtual continuing medical education sessions may aid primary care physicians in managing non-cancer medications for the cancer population. Trends in oncologists’ prescribing patterns from 2016–2020: Mean per-provider proportion of non-cancer medication prescription (%). Medication Class 2016 2017 2018 2019 2020 Cancer-Directed 30.4 31.1 32.2 32.7 33.9 Non-Cancer 9.5 8.9 8.2 7.6 7.4