Surviving cancer… then what?

Drs. Victor & Michelle Sierpina

Drs. Victor & Michelle Sierpina

The good news is that the numbers of people who have survived cancer is estimated to be more than 13 million in the U.S. alone.

 This is because of improved surgical and medical therapies, advanced radiation treatment and increasingly sophisticated imaging, genetic and molecular testing.

Early detection, screening, as well as increased understanding of how lifestyle factors can prevent and contribute to cancer prevention and survival also serve to prolong life after cancer.

Likely, most of you reading this either have a friend or family member who overcame cancer or you experienced a personal encounter with cancer.

The question is how are future health care needs met for these survivors? Once a patient has been diagnosed with cancer, the primary care physician’s role moves immediately to the background.

This can be true not only during active cancer therapy but also in the post-treatment period of surveillance.

After cancer therapy, patients may have a variety of residual issues like decreased function in the kidneys, heart, lungs or other organs.

The patient may also suffer from fatigue, pain, nausea, hypertension, gastrointestinal problems, bone and joint problems.

Some of these problems are best managed by cancer experts, but many may also fall into the realm of the primary care physician — the PCP.

This is especially the case if the patient is remote from the treating cancer center geographically or has been discharged from care.

The patient is best served through effective communication and collaboration between the treating oncologist and the PCP.

The patient can thrive by taking best advantage of the tremendous gains provided by cancer treatment experts at UTMB and other cancer centers combined with ongoing care with their PCP.

A study of lung cancer patients at a VA Hospital provides an example of the importance of this issue. Those who had a visit with a PCP within six months of their equal stage diagnosis lived an average of 16 months longer with the same treatment than those without a PCP.

One can easily reason why this might be. Attention to the need for these lung cancer survivors for medical management of coronary artery and peripheral vascular disease, hypertension, and COPD, immunizations, and monitoring of complications likely all contributed to this prolonged longevity.

Primary care physicians are well equipped to manage general health and medical issues, lifestyle medicine, preventive medicine, and attend to the biopsychosocial context of the whole person.

Holistic care by a familiar, trusted family doctor or internist can provide both comfort and reassurance to patients before, during and after cancer care.

The PCP can improve quality of life as well as longevity in cancer survivors by attending to the patients’ other health care issues.

A more robust “handoff” from oncologist to PCP can occur using a survivorship “passport.” Ideally, it outlines the planned surveillance strategies, suggested labs, ongoing medications, therapies for cancer or treatment related side effects.

Now that you have survived, remember the following:

It is essential to foster clear, compassionate, communication among cancer survivors, their primary care physician, and their treating oncologists to increase the quality of longitudinal care — a survivorship “passport” is one strategy to consider to enhance communication among all those involved.

Cancer survivors still need care of problems common in primary care and this need not differ radically from the processes for non-cancer patients.

Maintain ongoing liaison between the PCP and the oncologist when new problems arise to improve care and to offer a backstop for patient safety.

Take advantage of educational strategies and outreach for patients and community members to inform them of the latest information about cancer care. A perfect example is a planned series of lectures we encourage any of you touched by cancer in yourselves or loved ones to attend. Get details here on OLLI at UTMB Health Summer Oncology Lecture Series.

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