There should be as much focus on wellness as there is on surveillance for cancer survivors to improve outcomes for a growing proportion of the population, oncologists say.
According to a COSA position statement on cancer survivorship care, risk stratified pathways of care will also be required within a systematic, multidisciplinary approach.
Lead author Professor Janette Vardy, a medical oncologist at the University of Sydney, told the limbic that risk stratification and needs assessments were often ad hoc at present.
“So someone who is very well educated and particularly who had earlier stage disease with less intensive treatment and doesn’t have the same side effects, can be supported to do more self management.”
“And those with higher risk and more complex needs who had more intensive treatment, they may be requiring more specialised attention.”
“People with major psychological issues are going to require a different process to someone with bad peripheral neuropathy or someone who maybe doesn’t have the literacy skills to do as much self management.”
Not surprisingly, there is a larger role for GPs in supporting “wellness, healthy lifestyle and primary and secondary prevention” after cancer as there is in other chronic illnesses like diabetes.
“Because for many people, that’s what cancer has become,” Professor Vardy said.
“This position statement is trying to bring it together and saying that this is what we would suggest as a model of care and bringing GPs into playing a more active part than some do currently but making sure there is back-up for them as well.”
She acknowledged that challenges remain in patients’ access to some members of the multidisciplinary team.
“At the moment, cancer patients like other patients only get five allied health sessions per annum if they have an enhanced care plan from their GP. So if they have diabetes, that can be taken up completely by the podiatrist without any exercise physiologist or physiotherapist even getting a look in, let alone a psychologist.”
Central to the COSA model is a treatment summary and survivorship care plan, prepared by the specialist team with input from the patient and members of the team who would be implementing the plan.
“Probably one of the most important things is communication between the different health care professionals involved. The care plan can help a little bit with that,” she said.
“And there has also got to be a way back in to support the GP, particularly so if there is a problem so they can get very quick access [for their patient] back into the oncology system.”
Professor Vardy said the model was primarily designed in the interests of people with earlier stage disease and the potential for cure.
“Having said that it is equally applicable to people with more advanced disease and could similarly be applied to children or adolescents and young adults.”
She said recent guidelines on the role of exercise in cancer-related health outcomes reinforced the emphasis on wellness in survivorship care.
“In the past it was very much about surveillance. What we are saying is this needs to be far, far more than that.”