Madrid (EFE).- When a potentially cured patient ends a period of five or more years in the Oncology Service of his hospital, a new stage in Primary Care could begin, a moment that generates some uncertainty in the long survivors of cancer.
Achieving quality continuity of care in these patients is a challenge that, on the eve of World Cancer Day, is being pursued by the 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 lays the foundations for accompanying these patients at the different levels of public health care.
Advances in cancer therapies and early detection of cancer make it possible to cure more and more patients and even make the disease chronic in certain tumors.
This implies a sustained follow-up over time of the long survivors, not only to detect possible relapses, but also to treat the sequelae of the cancer, the side effects of the therapies and other comorbidities specific to each affected person, such as diabetes or hypertension.
A continuous attention necessary to survive cancer but also to do so with quality of life.
“We need other health levels, 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 Group of Prevention and Early Diagnosis and member of the SEOM Long Survivors Group.
For Dr. Roberto Bernal, coordinator of the SemFYC Cancer Working Group, long-term survivors of cancer “are a priority for general practitioners,” who are also trained to address the psychosocial problems of their patients in a society that is increasingly longevity
These doctors are part of the work team that is currently drawing up the guidelines for this protocol that they want to cross the borders of each autonomous community and even each hospital and become a minimum consensus document that serves the entire health system.
“This is a need that governments have to face both with resources and with the organization of care levels,” says Dr. Santaballa, a specialist in breast and gynecological tumors at the Oncology Service of the La Fe Polytechnic University Hospital in Valencia. .
A challenge that is taking place at a difficult time for Primary Care, further diminished after the covid pandemic and with its doctors involved in protest actions in defense of the first sanitary step.
“In Primary Care we already participate in the follow-up of the long survivor and we adjust to the available resources. It is a priority for us that the objectives for the benefit of the patient are met, resources must be optimized”, emphasizes Dr. Roberto Bernal, a doctor at a health center in Puerto Real (Cádiz).
One of the objectives is to try to undertake shared follow-up programs for these patients and for this there must be direct and continuous communication between the specialist and the family doctor (new technologies make it easier) with precise knowledge of the patient’s clinical history and the preparation of a follow-up report.
Another task is to organize a rapid referral route so that, if necessary, the patient returns to specialized care in the shortest possible time.
“The patient has to feel that we are all coordinated, that they do not feel lost in the system. This is not an abandonment, it is a continuation of his care, ”stresses the oncologist.
The training of family doctors is another of the points that the future plan will address in order to provide them with more tools to detect relapses or new tumors, also following the recommendations of international societies for each cancer.
The oncologist assures that it is a “myth” to believe that exhaustive follow-up or continuation in the hospital causes a possible relapse to be detected earlier, something that in most cases scientific evidence has not shown.
fear and uncertainty
After leaving behind several years, a minimum of five, in the hospital’s Oncology Service, patients may feel uncertainty, fear and insecurity upon discharge.
This is not the case of Catiana Martínez, representative of the Spanish Federation of Breast Cancer (FECMA), who remains in her public hospital in Murcia after years of control after having suffered, at the age of 31, a breast tumor and having suffered later a relapse.
“I feel more protected with my oncologist; I go for a review once a year and they have not 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 do not feel patient all their lives.”
However, he specifies, “there are still many points to coordinate” to make this referral effective at a time of “saturation” of Primary Care.
“It should not mean -he indicates- a decrease in quality, care, supervision, access to tests… That there is direct communication between the specialist doctor and the family doctor”, he affirms while asking that they be taken into account the opinion and experience of these patients.
Women with breast cancer are an example of long-term survivors, more than 80% of cases, who require continuity of care.
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 continuity of quality care for cancer patients.