When a patient, potentially cured, ends a period of five years or more in the Oncology Service of his hospital, he could begin a new phase in Primary Care, a time that generates some uncertainty in long-term cancer survivors.
Achieving quality continuity in the care of these long-term survivors is a challenge that, on the eve of World Cancer Day, they are pursuing Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Family and Community Medicine (SemFYC).
These medical societies have come together to work on a protocol that forms the basis for accompanying these patients at the different levels of public health care.
Advances in oncological therapies and the early detection of cancer make it possible to cure more and more patients and even delay the disease in certain tumors.
This involves a sustained follow-up over time of long-term survivors not only to detect possible relapses, but also to treat the sequelae of cancer, the side effects of therapies and other comorbidities specific to each affected person, such as diabetes or hypertension.
Continuous care necessary to survive cancer but also to do so with quality of life.
“We need other levels of health care, such as Primary Care, to accommodate the needs of these patients who, probably, should not always be kept in the oncology services of hospitals,” explains to EFE the oncologist Ana Santaballa, head of the Prevention and Early Diagnosis Group and member of SEOM’s Long-Term Survivors Group.
For Dr. Roberto Bernal, coordinator of the SemFYC Cancer Working Grouplong-term cancer survivors “are a priority for the general practitioner” who is also able to address the psychosocial problems of their patients in an increasingly long-lived society.
These doctors are part of the work team that is currently preparing the protocol guidelines that want to cross the borders of each autonomous community and even each hospital and be a minimum consensus document that serves the entire system sanitary
“This is a need that the rulers have to deal with both with resources and with the organization of care levels”, points out Dr. Santaballa, specialist in breast and gynecological tumors at the Oncology Service of La Fe Polytechnic University Hospital in Valencia .
A challenge that is brewing at a complicated time for Primary Care, diminished even more after the covid pandemic and with doctors involved in protest actions in defense of the first healthcare step.
“In Primary Care, we already participate in the monitoring of long-term survivors and adjust to the available resources. It is a priority for us that the objectives are met for the benefit of the patient, we need to optimize resources”, emphasizes Dr. Roberto Bernal, doctor at a health center in Puerto Real (Cádiz).
Objectives of the long-term survivor assistance protocol
One of the goals is to try to start a business shared tracking programs of these patients and for this reason there must be direct and continuous communication between the specialist and the family doctor (new technologies facilitate this) with precise knowledge of the patient’s clinical history and draw up a follow-up report.
Another task is to organize one rapid derivation route so that, if necessary, the patient returns to specialist care in the shortest possible time.
“The patient must feel that we are all coordinated, that he does not feel lost in the system. This is not an abandonment, it is a continuation of their attention”, emphasizes the oncologist.
The training of family doctors is another of the points that the future plan will address in order to give it more instruments to detect relapses or new tumors also following the recommendations of international societies for each cancer.
“The family doctor is able to detect the relapse but above all to prevent and treat the secondary effects of cancer and the chronic pathologies that the patient also suffers from,” says Santaballa.
The oncologist says that it is a myth to believe that a thorough follow-up or staying in the hospital means that a possible relapse is detected earlier, which in most cases the scientific evidence has not shown, although new tests such as the biopsy liquid can help give more information about patients prone to relapse.
Uncertainty and fear in patients
Leaving behind a few years, a minimum of five, in the hospital’s Oncology Service, long-term survivors can feel on receiving high uncertainty, fear and insecurity about what their medical care will be like.
It is not the case of Catiana Martínez, representative of the Spanish Breast Cancer Federation (FECMA)who is still in his public hospital in Murcia after years of control after suffering, at the age of 31, a breast tumor and then suffering a relapse.
“I feel more protected with my oncologist, I go to check up once a year and they haven’t referred me to Primary Care, nor have I asked for it,” he tells EFE.
But Catiana Martínez, also president of the Amiga Murcia Association, considers this return to the health center “positive” “so that women can close the process and not feel like patients for the rest of their lives”.
However, he points out, “there are still many points to coordinate” to make this referral effective at a time of “saturation” of Primary Care.
“It must not mean – he indicates – a decrease in quality, attention, supervision, access… That there is direct communication between the specialist and the family doctor”.
But it also asks that it does not lead to a delay in access to the tests and that they are not transferred to contracted private centers to take them.
“We believe that they do not meet the same guarantees of quality and accuracy as those that are made in public hospitals,” he says while asking that the opinion and experience of these patients be taken into account.
Women with breast cancer are an example of long survivors, more than 80% of cases, who require continuity of care derived from the sequelae of cancer and the side effects of treatments, such as endocrine therapies for women with tumors hormonal, more than 70% of all cases.
For this reason, these patients have been the starting point for SEOM and SemFYC to work on the design of a future protocol that ensures the continuity of quality care in long-term cancer survivors.