Survivorship or comprehensive care programmes

A second part of our meeting last month dealt with the topic of survivorship programmes for women who have been diagnosed with breast cancer.  What do we mean by a survivorship programme?  Should we not amalgamate all into a comprehensive care programme?

Linda Greef with Oliver Hart
Dr Heide Hart ran the session.  She was ably assisted her youngest son: Oliver Hart.  She started by defining the need as stated by the American Cancer Society: cancer patients face particular physical, psychosocial, practical and spiritual challenges.

What would a survivorship programme for women who have had breast cancer aim to do?  Ideally, it would coordinate care providing a multidisciplinary approach to cater for the needs of the individual.  These differ and are dependent on the age of the individual, the type of cancer and the treatment given.

Broadly, the following should be offered:
Information about screening programmes for other cancers (e.g. ovarian cancer)
Cardiac assessment post chemotherapy
Exercise programmes
Dietary advice                              
Lymphoedema management
Psychiatric help and assessment of cognitive function
Sexual advice
Pain assessment.
Dr Heide Hart

How should the programmes be run? In some centres, a survivorship specialist runs ongoing programmes and refers individuals to specialists as necessary.  Alternatively, each person could be discussed by a multidisciplinary team and an appropriate programme offered.  When possible, the shift should be for the majority of care to be provided by the primary care physician rather than the specialist.

However, the notion of "survivorship" is complex. What happens to women who develop metastatic disease?  Do they "fail" a survivorship programme?  We were fortunate to have Dr Rene Krause (a palliative care specialist) to add her perspective.  She suggested that rather than think in terms of a survivorship programme, each individual should be referred for comprehensive care.  This includes input from palliative care specialists.

When should a palliative care team be involved? The WHO have recommended that they should be involved from the time of diagnosis.  Dr Krause feels that they should be involved as soon as metastatic disease has developed.  Others argued that as many women with systemic breast cancer live for many years, it is too early.  We didn't reach a consensus.

Ideally, comprehensive care should be offered to any person who has been diagnosed with cancer. This should be from the time of diagnosis with the relevant specialists adding to broad based care as appropriate.

Please share your experience.


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