Moving forward clinic and survivorship
Breast cancer is the most common malignancy in women in the UK (1 in 8), the incidence of the disease has risen by 6% over the last 10 years, mortality rates have steadily fallen, and currently 80% of patients with early breast cancer have a projected survival of >10 years. The number of patients living beyond a breast cancer diagnosis has steadily grown; there were estimated to be 500 000 breast cancer ‘survivors’ in the UK in 2010 but this number is expected to reach 2 million by 2040. Once surgery and any chemotherapy and/or radiotherapy treatments are complete, the traditional model of breast cancer follow-up of multiple routine hospital visits has largely been superseded by an ‘open access’ structure, focusing on supporting self-management and patient empowerment. To make such a service successful, it is suggested that each patient should receive a Recovery Package, consisting of the following components:
- Cancer care review: review by a primary care practitioner within 6 months of a cancer diagnosis to ensure patients know what services are available to them, embedding the principles of self-management at an early stage.
- End of treatment summary: outlines treatments completed and priorities for future care, including any planned surveillance (for example, annual mammograms) and advice on symptoms and signs that could indicate recurrence;
- Health needs assessment: comprehensive questionnaire completed by the patient, including a concerns checklist, distress thermometer, and care plan;
- Health and wellbeing events: group events that provide an opportunity for patients to be educated on issues such as how to maintain a healthy lifestyle and management of long-term consequences of cancer treatment.
These measures should enable rapid and appropriate self-management or self-referral back to a hospital breast unit, but it is also important that GPs are aware of the common problems and concerns affecting this population.