Two million people in the UK have had a cancer diagnosis and, due to improvements in diagnosis and treatment, the numbers of survivors are increasing. According to the National Cancer Institute, cancer survivorship encompasses the ‘physical, psychosocial, and economic issues of cancer from diagnosis until the end of life.’1 Hospital clinics are often overbooked with follow-up of survivorship patients, with little time available for each patient. Involvement of community-based care in survivorship has been shown to be beneficial. Follow-up for prostate cancer survivors through the UK varies, with some being discharged back to their GP and others remaining under secondary care. Cancer survivors may present to their GP after surgery and hospital discharge with a range of problems.
At Worcestershire Acute Hospitals, prostate cancer patients are offered entry to our new Survivorship programme, set up in 2009. Patients who have initial therapy with curative intent for organ confined-disease (surgery, external beam radiotherapy, or brachytherapy) are invited to join. Patients must have survived 2 years after radical prostatectomy, with an unrecordable PSA reading, 3 years after external beam radiotherapy with no metabolic relapse, or brachytherapy with no metabolic relapse. Recurrence is monitored by PSA measurements. After being discharged their details, including PSA measurements, are entered into a password-protected database by a specialist nurse, who acts as the patients’ keyworker. This database can generate alerts if the PSA is elevated so that patients can be brought back to the clinic by the specialist nurse who can also respond to symptoms or signs of recurrence, adverse effects of treatment or a patient’s request. We have over 500 patients on this programme.
When we investigated GPs’ views of this programme we detected low confidence levels in managing relapsing/hormone resistant breast and prostate cancer, and in the management of side effects. Half of the GPs were not fully informed about the survivorship programme, which is designed to remove this burden of care from general practice, and many had misconceptions about the programme: 25% thought it was a programme to empower patients who are cured, and 15% thought it simply offered a holistic approach. The purpose of this programme is, of course, to keep patients under surveillance in the community while under the clinical governance umbrella of secondary care.
We aim to promote this programme among the general practice community and to involve patients with active disease being treated in the community.
- © British Journal of General Practice 2013