Who should take care of cancer patients after treatment?

The cancer journey is an emotional and challenging experience, and many patients find themselves forming deep bonds with the people they saw go through their toughest time – their oncologist. So when treatment is over and it’s time to go back to their primary care doctor, some patients have trouble letting someone else take charge of their care. “Patients generally trust their medical oncologist and many are reluctant to leave,” says Anthony Berry, M.D., director of new patient admissions and deputy chief of staff at our hospital in Philadelphia. “Currently, most patients do not enjoy a smooth transition from cancer care to primary care.”

This transition is important, adds Dr. Perry, speaking as a physician and as a survivor of Hodgkin lymphoma. While patients should continue to see their oncologists for regular follow-up visits, maintenance therapy, or other cancer-related needs, primary care physicians should take the lead in monitoring and treating other health needs. They may have, from high cholesterol and high blood pressure to asthma and obesity. In an ideal world, says Dr. Perry, the oncologist would set the tone for the patient from the first oncology appointment onwards, and inform the primary care physician about the entire cancer treatment process, from diagnosis results to the type and stage of the patient’s cancer through to the treatments they receive. This is what Dr. Berry calls a shared model, and its goal is to reduce the disconnect that can arise between the patient and the primary care physician during treatment.

Who sees after cancer treatment?

That separation is still alive and well, according to a recent study that found that many cancer survivors want their oncologist to manage their health care needs after their cancer treatment is completed. Dr. Berry says that most oncologists are not equipped to handle preventive health care like their primary care counterparts. “The most common reasons for seeing a doctor, other than cancer, are problems like cardiovascular disease, diabetes, and high blood pressure — issues that most oncologists don’t have experience diagnosing and treating,” he says.

Published July 12 in the Journal of Clinical Oncology , the survival study also highlights another problem noted by Dr. Perry himself: Most oncologists do not do enough to educate their patients about the need to see primary care physicians for follow-up care or to involve patients and primary care physicians in a transition plan. . “My experience has been that most primary care physicians quickly refer cancer survivors to an oncologist, but part of the medical oncologists’ responsibility is to provide a plan after treatment is complete so they can share their experience with their primary care physician and make the transition smoother,” he says.

This plan, more commonly known as a survivor’s care plan, should include information about the patient’s illness, doctors, treatments, cancer follow-up appointments, tests, and side effects associated with treatment. Not all cancer patients receive a care plan to survive after their treatment ends, but Dr. Perry believes that most patients should do so. As an example, he cited the chemotherapy drug tamoxifen ( ^Nolvadex®), which are usually taken by premenopausal women and those treated for estrogen receptor-positive breast cancer to prevent cancer recurrence, should not be taken with some antidepressants because they may reduce the effect of tamoxifen or even increase the risk of cancer recurrence. . “This is important information that primary care physicians need to know, but not many of them do,” Dr. Perry says. “When I formulate a survival care plan for these patients, I include a list of antidepressants to avoid and a list of antidepressants least likely to interact with tamoxifen.”

Survival Care Plans

Survival plans are so important that the Committee on Cancer, the American College of Surgeons’ program that accredits cancer programs in the United States, recommended that by the end of 2018, oncologists would provide survival care plans. to at least 75 percent of patients. Patients deemed eligible and completed treatment.

With more and more cancer patients surviving the disease, both oncologists and primary care physicians must treat cancer medical care as a long-term necessity, not a short-term one, says Dr. Beach. This means that the fight is no longer just against cancer. “If you don’t do other things as well, like eat a healthy diet and get enough sleep and exercise, then by the time you’re 60 or 70, you may be more likely to get other types of cancer, as well as heart disease and stroke.”

Learn more about developing a survival care plan after cancer treatment.