The key to good care for cancer survivors

By Lewis Foxhall, MD


Every cancer patient wants to successfully complete active treatment .  Thanks to improved treatments and use of cancer screening programs (which can find cancer early, when it’s most treatable), this goal is being reached more frequently than ever. 


But to get the most out of treatment there is more you can do.  A proactive approach to care for cancer survivors has developed over the last few years. This includes traditional follow up looking for any signs the original cancer has come back.  It also includes active management of any lingering side effects of treatment, testing for new cancers, and addressing psychological and social problems that may develop or persist after treatment.  This approach is intended to give you the greatest benefit from your treatment so you can live longer, and better. [more]


Good communication matters

The key to successful care of cancer survivors is effective communication. Communication between you and your health care team, as well as between you and your family and caregivers is critically important to making sure you’re getting good, complete care. 


A vital part of this communication is a clear understanding about who is responsible for each part of your long-term care. Your treating oncologists are usually quite comfortable with the traditional follow- up tests to see if the cancer has returned, and oncologists are also familiar with various symptoms that may mean the cancer has returned. 


However, some surveys show that patients feel their primary care physician may be better at managing cancer screening and prevention as well as mental health issues. The primary care physicians interviewed say they do feel like they can manage follow up for all the needs of stable cancer survivors. 


But a lack of communication can occur if oncologists and primary care physicians do not share information about your care, and confusion may develop about who is responsible for the different parts of the your care.


Summary of care and care plan

A solution to this problem is the cancer survivor summary of care and the care plan proposed by the Institute of Medicine (IOM).  This will soon become a required component of every cancer patient’s medical record. This document serves several purposes:


  • It can be best used as a reminder for you and your clinicians to talk with each other; everyone involved in your care needs to understand the treatments you received and any side effects that need to be managed.
  • It should help you be clear on any future tests that you may need to look for a recurrence of your cancer. These may include CT scans or blood tests, for instance, depending on your specific cancer and situation. You and your care team should discuss the specific tests you need and how often you should have them.
  • Your care plan should also include a schedule for tests to look for new cancers (screening). People who have been successfully treated for some cancers may have a greater chance of having another cancer, so understanding your risk and following screening recommendations is crucial. This is an area where there may be confusion as to who is responsible for keeping track of these tests, so it is particularly important to discuss this with the health care team members.


The American Cancer Society has links to some survivorship care plans here.


Take care of your emotional health


You should also have an open discussion about all mental health needs or other problems you, your family, and your caregivers face that might affect your quality of life. Common problems include stress, depression and anxiety


You and your caregivers may find these problems difficult to discuss, but bringing them to the attention of the oncologist or primary care clinician is important to finding a solution. These can often be managed through counseling or medications that are usually well tolerated and effective. 


At times, more challenging psychological problems may develop, and you may find it helpful to talk with a psychiatrist or psychologist.  Social workers may be very helpful in addressing  issues such as difficulties returning to work, or financial and insurance problems. 


Attend to your overall health, too


Getting the most from the difficult treatments you experienced also means taking care of yourself in other ways. Healthy living — including not using tobacco products, maintaining a healthy weight, getting regular exercise, and eating a healthy diet and limiting alcohol — can make a big difference. In fact, while study results vary, studies in some cancers show a possible association with reduced recurrence in those patients who live a healthier lifestyle.


If you have other medical conditions such as high blood pressure or high cholesterol, these should be treated to reduce your risk of heart disease.  More people die of heart disease than cancer.  Being vaccinated for influenza (flu), pneumonia, and other conditions are also very effective in reducing your risk of these conditions.  Ask you oncologist or primary care clinician which vaccines you should receive and be sure one of your health team members takes responsibility for reminding you about them.


As a cancer survivor you have finished treatment, but you can still do a lot to protect yourself and get the most out of the treatment you received.  These actions will also help you maintain the best possible quality of life. 

In short, you should talk with your health care team about a care plan that includes the following:

1. Summary of your cancer treatments

2. Your plan to screen for early signs of relapse or for early detection of other cancers

3. How to talk about and address any emotional or social problems

4. How to maintain a healthy lifestyle and plan for general preventive measures

Dr. Foxhall serves on the Board of Directors for the American Cancer Society nHigh Plains Division and the American Cancer Society Cancer Action Network. He is vice president for health policy and is a professor, department of clinical cancer prevention, for the University of Texas MD Anderson Cancer Center in Houston, Texas.

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