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Primary care physicians must know cancer details

BY DR. DAVID LIPSCHITZ Published: April 9, 2012
The Centers for Disease Control and Prevention reports there are more than 12 million cancer survivors, and that number will likely double in the next few decades as the population ages.

In 2005, the Institute of Medicine published a report highlighting the special concerns of cancer survivors.

Their report, "From Cancer Patient to Cancer Survivor: Lost in Transition," pointed out the numerous problems these patients face, including persistent side effects from treatment, the health problems that can occur at any time from either the cancer or its treatment, and the lack of understanding by the patient and his family about what to expect, who should be responsible for care, and what and when screening and other tests should be done.

Many patients do not understand the nature of their disease and are insufficiently educated about the treatment plan, prognosis, chance of cure, and the risk of recurrence.

They are not told what symptoms to expect and as a consequence, any minor malady — particularly pain — leads to panic and trips to the doctor with concerns that the cancer has recurred.

Every practicing physician has faced issues such as this and watched the profound relief on patients' faces when they are reassured that the cancer has not returned.

Even the health care community is unsure of who should be responsible for monitoring patients and what tests should be done. Often the primary care physician has not been provided with detailed and understandable information on the diagnosis, treatment plan, side effects, and chance of recurrence.

As a consequence, many primary care physicians cede all care to the main cancer therapist, who may be a surgeon, a medical oncologist or a radiotherapist.

With no one in charge, screening may be either overzealous or inaccurate, and the management of other medical problems may be inadequate. On occasion, a side effect from the treatment (for example, heart damage caused by certain chemotherapy drugs) may be missed or not appropriately monitored.

It is not surprising that numerous reports have shown that fewer than half of primary care providers feel comfortable monitoring their patients for potential late side effects of cancer therapy.

Today every leading research and cancer advocacy group recommends that cancer survivors be given a detailed and easy-to-understand care plan that promotes patient understanding and comfort and provides physicians with a road map for future care.

Although this recommendation was made in 2005, fewer than half of the best cancer centers designated by the National Cancer Institute of the National Institutes of Health provide their patients with these care plans — even for the most common cancers, such as breast and colon.

Every cancer survivor should insist that the cancer specialist provide a written plan that should be understandable but detailed enough to be of value to the patient and any physician involved in his or her care.

This plan must include the diagnosis, the tests performed and the nature of the cancer.

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