A cancer diagnosis can be life-changing, but what a patient experiences after treatment is sometimes just as overwhelming. Although their cancer may be gone, a patient might wonder about plans for follow-up and may experience the late or long-term effects of cancer treatments.
To better address the unique needs of survivors, Dayton Physicians Network (DPN) is leading the way in community oncology with a comprehensive cancer survivorship program that offers a more holistic approach to patient care. Dr. Beth Delaney, a nurse practitioner with DPN, helps patients understand what they just went through, offers a clearer vision of what happens next, and creates a plan to minimize future risks.
The program currently supports survivors of stages one-through-three breast, colon, and, soon, prostate cancers. “Survivorship is about taking care of the whole person — physically, emotionally, and spiritually,” Delaney explained, emphasizing the human aspects of treatment that can be overshadowed with the urgency of the illness.
The survivorship visit is scheduled three-to-four months following the completion of initial therapies and lasts about 30 minutes. Before the visit, the patient’s records are reviewed to create a tailored survivorship care plan, covering everything from medication lists and healthcare provider information, to diagnosis and treatment summaries, and any late effects they may have experienced.
Each patient is asked to complete a survivorship assessment. The assessment is like a survey, or screening tool, used to determine long-term and late effects related to the cancer and treatment.
“This helps us look at new physical symptoms that may emerge because of the cancer treatment,” Delaney said. “Is the patient experiencing depression, nutritional deficiencies, or other symptoms? Are they exercising and maintaining normal activity? We also address the specific needs of men and women who have suffered challenges with sexual function and intimacy resulting from breast, colon, or prostate cancer treatment.”
Patients may be unaware of these after-effects. “We are one of the first accredited oncology medical home models in the United States and are pleased to offer cancer survivorship so that patients don’t suffer in silence because of post-treatment effects.”
“During the visit, we review the survivorship care plan with the patient to help them understand the whole picture of what has happened to them and what is coming next,” Delaney said. “Patients are very happy to have the plan to take home because it’s a one-stop, summary document of information regarding their journey with us at Dayton Physicians.”
If the patients are willing and interested, the staff also review current healthy lifestyle information that may reduce potential cancer recurrence. The program can help them maintain a healthy lifestyle, through exercise, immunization, monitoring of caffeine use, and any appropriate community referrals. Patients also receive a folder of information about lifestyle behavior choices.
If all of this sounds kind of new, that’s because cancer survivorship programs, thus far, have been more prevalent in academic medical centers. The community services often are provided at no cost to patients, and Delaney feels that most are grateful and glad they participated.
“Since the program is so new, people don’t always understand why they’re coming to the visit,” she said. “It’s not unusual for patients to be given their diagnosis and staging information, and then they are left in a fog. Some of that time is very overwhelming, and they don’t have full retention of that information. The survivorship visit can help clear some of that fog.”
Additionally, with proper support and education, patients can do more to reduce the risk of recurrence and new kinds of cancer. “There things under your control that can help reduce your cancer risk,” Delaney said. “For example, a smoker who goes through a breast cancer treatment may still find it very hard to quit. So, we provide support to help them quit smoking, to improve quality of life and reduce the potential for recurrence or even new kinds of cancer.”
Finally, one of the most critical pieces of the survivorship care plan is the monitoring and surveillance portion. This includes information on when to see the oncologist, other specialists, or the primary care physician, when does the patient need imaging and blood tests, what self-exams do they need to be doing, and what is the timing of each component.
Delaney points out that DPN has established this program not just because the national standards of managed cancer care are moving in this direction, but simply because it is the right thing to do. “We know, from the research, that people who have gone through survivorship programs have improved pain management, better sleep and well-being, reduced anxiety, and more empowerment.”