Making a Place for Cancer Survivors
Two years ago, breast oncologist Lidia Schapira, MD, approached Kim about starting a survivorship clinic. First, Kim had to read up on what Schapira meant.
“In all my training, I hadn’t even heard of the word survivorship,” says Kim.
But the more she read-and the more meetings and seminars on survivorship she attended-the more intrigued she became. She agreed to start a pilot program; she spent time shadowing oncologists at Stanford so she’d better understand the ins and outs of cancer treatment. Then she set aside two half-days a week to see patients with breast and gynecologic cancers from the Stanford Women’s Cancer Center.
She helped address specific problems each patient might be having, whether or not the issues were related to a tumor, and set up a long-term plan for cancer screening and primary care needs. The model was immediately successful, with positive feedback from patients and oncologists alike, and Kim’s schedule filled. Since then, she’s expanded to see people who are survivors of lung, colon, and childhood cancers.
For some people, one appointment with Kim is enough to send them on their way with a plan. For others, it may require months of follow-up before they feel ready to move to another primary care provider. In either case, Kim gives them information to pass along to their doctor-or, if they’re continuing to receive care at Stanford, she might call or message the primary care provider directly.
“The advantage of me doing this instead of an oncologist is that I know what most primary care doctors can understand,” says Kim. “I try to hand off recommendations that are manageable and not full of the kind of detail and inside jargon that oncologists might use.”
Survivorship Education for Doctors
Kim can see only so many patients, but her hope is that as more primary care doctors become aware of the unique needs of cancer survivors, others will step up. To that end, Kim and Schapira designed an online continuing education course for primary care doctors to learn key points about survivorship-common long-term and delayed effects of chemotherapy and radiation, for instance.
“You don’t need to be a survivorship expert to integrate these things into your everyday practice,” says Kim. For instance, if someone who once had prostate cancer treatment complains of frequent urination to their primary care doctor, they might normally test for diabetes or pelvic floor issues. But simply being aware that this can be a delayed complication of prostate cancer treatment can help them treat it more appropriately.
She thinks that with a little extra education, primary care doctors can become more comfortable treating cancer survivors. Rather than referring these patients back to oncologists, primary care physicians armed with the right knowledge can handle many of the long-term effects of cancer and cancer treatment on their own.
“Survivorship is a chronic disease, just like diabetes and high blood pressure,” says Kim. “So it’s appropriate for primary care doctors to manage these patients who need a little extra care; it’s just that some training is needed for us to get there.”
Originally published at https://medicine.stanford.edu.
