Involvement of primary care in cancer survivorship

Leah Zajdlewicz – Research Officer (Cancer Council Queensland)
Joanne Aitken – Head of Research and Director of Cancer Registries (Cancer Council Queensland)

Published 2 May 2014

Leah & Joanne

Around 128,000 new cases of cancer will be diagnosed in Australia this year, with that number set to increase to 170,000 by 2025 (Baade, Meng, Sinclair, & Youl, 2012; Smith et al., 2007).  At the same time, more people are surviving cancer today than any other time in history – around 66 per cent of people diagnosed with cancer in Australia survive for at least five years after their diagnosis (Australian Institute of Health and Welfare, 2012). The combination of increasing cancer incidence and longer survival is reflected in the most recent national prevalence statistics that indicate that over 770,000 Australians who were alive in 2007, or just over 3% of the population (Australian Institute of Health and Welfare, 2012; Smith et al, 2007) had had a prior diagnosis of cancer.

While more people are surviving cancer than ever before, they are not necessarily surviving well and the need to understand the challenges faced by cancer survivors and how to address these is becoming more and more pressing. A significant proportion of cancer survivors  experience ongoing difficulties including  physical, psychological and practical problems related to the diagnosis and/or treatment of their cancer (Hewitt, Greenfield, & Stovall, 2005) . Evidence suggests that while follow up care focuses primarily on cancer recurrence, spread and the early identification of new cancers, there remain unmet needs for supportive care and physical, practical, informational and emotional help for survivors (Boyes, Hodgkinson, Aldridge, & Turner, 2009; Hewitt, et al., 2005). On a population level, there are significant geographic and socio-demographic differences in cancer survival and the quality of survivorship that need to be understood and addressed (Baade, Youlden, Coory, Gardiner, & Chambers, 2011).

GPs and the care of cancer survivors

Current methods of service delivery involve a hybrid model of care whereby oncologists and/or primary care physicians provide follow-up treatment to cancer patients. However there are barriers to optimal care utilising this approach (Lofti-Jam, Schofield, & Jefford, 2009) and patients can too easily be lost to follow up (Hewitt, et al., 2005).Given this, there is increasing recognition of the need for General Practitioners (GPs) to take the lead in managing the long-term physical and emotional needs and ongoing provision of information that would help patients to better cope with the ebbs and flows of post-treatment life.

While there is a growing preference for GPs to take a central role in follow up care (Brennan, Butow, Spillane, & Boyle, 2008; Brennan, Butow, Spillane, Marven, & Boyle, 2011), further research needs to be conducted in Australian settings to compare and assess models of care and the outcomes from utilising survivorship care plans (Baravelli et al., 2009).  There is also a call for greater awareness and understanding of the pathophysiology of symptoms to improve management of patients who have completed their cancer treatment (Australian Doctor, 2014). International models of care for cancer survivors have been implemented and assessed and randomised control trials comparing GPs with hospital treatment facilities have found that GP care is more cost-effective and as acceptable to patients as other models (Grunfeld, Fitzpatrick, et al., 1999; Grunfeld, Gray, et al., 1999; Grunfeld, Yudkin, Adewuyl-Dalton, Vessey, & Mant, 1995).

Increases in the numbers of cancer survivors and the need for optimal and long-term follow-up care for those affected raises challenges for the healthcare system and its workforce, yet, the ongoing impact of cancer has largely been overlooked in models of primary care, despite the potential long-term consequences for patients. As such, there is an urgent need to conduct well-directed and in depth descriptive studies to improve our understanding of the needs of survivors and the best ways to develop and evaluate responsive, equitable and accessible interventions for those who have been diagnosed with cancer.

Cancer Survivor Study

To help address this need, on 6 February 2014, Cancer Council Queensland launched a community-based, Australia-first study of the needs and concerns of cancer survivors, the Cancer Survivor Study. Cancer Council Queensland is inviting all cancer survivors to complete the survey and, by doing so, to help us document, assess and report the huge range of emotional, physical and practical concerns of cancer survivors.  Ultimately, the information provided will facilitate the development of improved, much needed support for this growing group of Australians.

Cancer Council Queensland asks GPs to assist by letting their patients know about the Cancer Survivor Study and encouraging their patients to complete the survey, so that together we can understand more about the cancer journey beyond treatment. More detailed information, and the survey itself, can be found at www.survivorstudy.org.au

Please take the time to download the Cancer Survivor Study information page and posters, as well as a video showing the inspiring story of a cancer survivor.

References

Australian Doctor. (2014). How to Treat

Australian Institute of Health and Welfare. (2012). Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer series no. 69. Cat. no. CAN 65. . Canberra: AIHW.

Baade, P. D., Meng, X., Sinclair, C., & Youl, P. (2012). Estimating the future burden of cancers preventable by better diet and physical activity in Australia. Med J Aust, 196(5), 337-340. doi: baa11082_fm [pii]

Baade, P. D., Youlden, D. R., Coory, M. D., Gardiner, R. A., & Chambers, S. K. (2011). Urban-rural differences in prostate cancer outcomes in Australia: what has changed? Med J Aust, 194(6), 293-296. doi: baa11256_fm [pii]

Baravelli, C., Krishnasamy, M., Pezaro, C., Schofield, P., Lotfi-Jam, K., Rogers, M., . . . Jefford, M. (2009). The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up. J Cancer Surviv, 3(2), 99-108. doi: 10.1007/s11764-009-0086-1

Boyes, A., Hodgkinson, K., Aldridge, L., & Turner, J. (2009). Issues for cancer survivors in Australia. Cancer Forum, 33(3).

Brennan, M., Butow, P., Spillane, A., & Boyle, F. (2008). Survivorship care after breast cancer. Aust Fam Physician, 37(10), 826-830.

Brennan, M., Butow, P., Spillane, A. J., Marven, M., & Boyle, F. M. (2011). Follow up after breast cancer — views of Australian women. Aust Fam Physician, 40(5), 311-316.

Grunfeld, E., Fitzpatrick, R., Mant, D., Yudkin, P., Adewuyi-Dalton, R., Stewart, J., . . . Vessey, M. (1999). Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Pract, 49(446), 705-710.

Grunfeld, E., Gray, A., Mant, D., Yudkin, P., Adewuyi-Dalton, R., Coyle, D., . . . Vessey, M. (1999). Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation. Br J Cancer, 79(7-8), 1227-1233. doi: 10.1038/sj.bjc.6690197

Grunfeld, E., Yudkin, P., Adewuyl-Dalton, R., Vessey, M. P., & Mant, D. (1995). Follow up in breast cancer. Quality of life unaffected by general practice follow up. BMJ, 311(6996), 54.

Hewitt, M., Greenfield, S., & Stovall, E. (2005). From Cancer Patient to Cancer Survivor: Lost in Transition: The National Academies Press.

Lofti-Jam, K., Schofield, P., & Jefford, M. (2009). What constitutes ideal survivorship care? Cancer Forum, 33(3).

Smith, D. P., Supramaniam, R., King, M. T., Ward, J., Berry, M., & Armstrong, B. K. (2007). Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol, 25(18), 2560-2566. doi: 10.1200/JCO.2006.09.8046