Moving on after cancer treatment
Research shows generalists are very well-suited to help cancer survivors thrive after treatment
If you’ve been through cancer treatment, at some point you will likely be transferred back to your family doctor or nurse-practitioner for followup care.
You may have initial worries — what if they miss a sign of the cancer returning? Some fear their family doctor won’t feel comfortable or knowledgeable taking care of post-cancer patients.
But the evidence shows very much the opposite.
Transferring back to primary care has become increasingly common in Ontario for over a decade. It’s part of a healthy trend: All over the world, patient advocates, doctors and policy-makers have started paying a lot more attention to survivorship — how to help people live long and well after cancer.
Survivorship care focuses on the health and life of a person with a history of cancer, including:
Managing medical issues that were present before cancer, as well as new medical issues (including side effects of cancer treatments);
Assessing for symptoms to make sure the cancer has not come back;
Treating any late side effects of cancer treatments; Providing emotional support; Making sure patients stay healthy through prevention such as vaccines, screening for other cancers and medical conditions, and supporting a healthy lifestyle through good nutrition, exercise and smoking cessation.
Clearly, family doctors and nurse practitioners are in the best position to offer such a wide range of services. And extensive research supports this by showing no differences in cancer recurrences, death rates or quality of life between patients who receive their followup care after cancer treatment by a family doctor or nurse practitioner versus an oncologist.
So how does your family doctor feel about assuming this care? A survey of family doctors across Canada that I published found almost all were willing to take over a patient’s followup care for lymphoma, breast, colon and prostate cancers. Many responded that they were already exclusively providing this care.
In truth, I’ve found many patients prefer it. This, too, is supported by surveys of cancer patients who have completed treatment and are considered cured or in remission. They’re relieved to be done with the long waits and expensive parking at the cancer centre — not to mention the anxiety of returning to the place they underwent unpleasant treatments. Seeing their old family doctor for their medical care feels like another step in the re-establishment of normalcy. Some joke that it’s almost like they graduated and can move on from their cancer.
Of course, I always hope my patients will keep seeing me throughout their
treatment. Often people going through the crisis of cancer tend to neglect their other medical issues, such as their blood pressure or that chronically painful lower back preventing them from exercise (which in turn stops them from gaining back their energy). A generalist is in the best position to manage these chronic illnesses, as well as help people recover from the side effects of treatment.
Family doctors in Ontario are very accustomed to ordering tests to look for signs of recurrence or new symptoms. With our patients who have a cancer history, we actually tend to err on the side of more testing and monitoring than what is recommended. And rest assured, the scans we order are being read and interpreted by radiologists regardless of who does the ordering.
If your oncologist has decided to transfer you back to your family doctor, it won’t be a big transition if all along you have been seeing your family doctor. But either way, I always recommend a few things to ensure a smooth transition.
Double-check that all the appropriate paperwork is travelling with you. Some cancer centres are better than others at keeping a patient’s family doctor informed: You may be surprised to learn they were receiving updates and closely following your course of treatment all along. Others may know little to nothing. You’ll want your family doctor to have the important information about your cancer treatment, any problems you had along the way or lingering side effects.
Most important, though, is the written discharge report that your oncologist will provide to your family doctor. This should include all the instructions your family doctor will need to take over your care. It would be good to keep a copy of it in your home records as well.
It’s best to make a dedicated appointment to sit down and talk to your family doctor about the transition of your cancer care. Make sure she or he has all the right documents and that both of you have the same understanding moving forward of what will be in involved in your individualized cancer care plan. That meeting would be an excellent time to bring up any treatment side effects, such as brain fog, exhaustion, or ongo- ing pain or discomfort.
If you’re worried about something that your family doctor can’t address, you can always ask him or her to refer you back to the cancer centre for a consultation. And if any important changes occur in the long-term management of your type of cancer, you or your family doctor will be contacted.
A healthy survivorship includes addressing your cancerrelated fears or worries. If these include transferring back to your family doctor, please don’t hesitate to express your concerns to your cancer specialist.