Under the title “Present and future of the long-term cancer survivor patient: Discovering new horizons for addressing their clinical and social needs”, the experts have analyzed the situation of this group. “At the present time the concept of long survivor has undergone a change with respect to what we considered until now in Oncology,” the Dr. César A. Rodríguezpresident of SEOM.
Multidisciplinary approach
Throughout it, it has been insisted that the management of long-term surviving patients must have a multidisciplinary approach. And this is established in the document. It is committed to shared monitoring between “hospital specialists and Primary Care specialists from the moment of diagnosis,” as the Dr. Ruth Vera, coordinator of the SEOM Group of Long-Term Cancer Survivors, to EL MÉDICO INTERACTIVO. The document proposes multi-stage and interdisciplinary care, and an individualized model by type of cancer, evolution, age of the patient, social and family environment, etc. And assisting this group is a job that involves different professionals, both doctors and nurses, psychologists, social workers, etc. In short, a shared model. Therefore, the words “communication and coordination” have been present in all the interventions. Something that, as has been concluded, is not adequately resolved in our healthcare system.
Fluent communication with INP
And how to improve this coordination between levels of care and make patient care more efficient? SEOM is committed to fluid communication between Primary Care and the Oncology services of hospitals through the INP (non-face-to-face consultations). “There must be established fast circuits response to Primary Care,” commented Dr. Vera. Regarding the areas in which to focus research in the field of long-term cancer survivors, the person in charge of this working group highlighted to EL MÉDICO INTERACTIVO that one of them would be identifying the current and future needs of patients in a world changing and another very important one is the measurement of the strategies in terms not only of cure but also of quality of life and unmet needs of patients. “Investigate and measure to be able to provide solutions,” said Dr. Vera.
Role of PA in long survivors
For her part, the family doctor Yolanda Ginés, a member of the Cancer Working Group of the Spanish Society of Family and Community Medicine (semFYC), focused on the role of this level of care in addressing long-term survivors. “Primary is in the care of people throughout their lives and is essential for prevention, monitoring, and control of risk factors or the appearance of other tumors.” And, as has been recalled, in these patients there is a higher incidence of cardiovascular problems, metabolic syndrome, osteoporosis or obesity; in addition to mental health problems such as anxiety or depression. Therefore, he demanded more managerial involvement to improve coordination between levels of care. As he pointed out, there are models that have already been implemented in Spain and that are working in coordination to monitor long-term survivors “but it is not the generality throughout the Spanish territory.” Shared management is the ideal model of care for long-term cancer survivors. Furthermore, this management should be sequential in the different evolutionary stages of the disease, it was stressed again, “from diagnosis and treatment to the follow-up phase, so that the weight of care will fall to a greater or lesser extent on Primary Care.” u Hospital based on the moment in which the patient is, their priorities and/or care needs at each moment,” commented, for its part, the Dr. Rosario Vidalmedical oncologist at the Salamanca University Care Complex.
Lack of protocols
“The needs of a long-term cancer survivor, especially if they have been diagnosed at an early age, are very broad and affect both an organic, psychosocial and neurocognitive level. This is a slab that they will have to carry for many years and that unfortunately the health system does not have adequately covered, there being a great lack of protocols of assistance to this group”, detailed the Dr. J. Alejandro Pérez-Fidalgo, medical oncologist at the University Clinical Hospital of Valencia and researcher at Incliva. In this sense, as Dr. Vera advanced at the beginning of the session, the SEOM manifesto establishes five types of needs. Physical, generated by the tumor itself or those generated by the treatment; psychological, since up to 20 percent of patients who have suffered cancer have depression and/or anxiety; from the social, financial and occupational sphere; needs in the recurrence or development of second tumors; and, finally, needs in the area of prevention of other pathologies associated with having suffered from cancer.
Psychosocial needs
Psychosocial support has been another key in the management of these patients, which has been present at each and every one of the tables of the day. The Dr. Elena Brozos, a medical oncologist at the A Coruña University Hospital Complex, pointed out that long-term cancer survivors can suffer from self-esteem, sexuality and even fertility problems. For this reason, she stressed the importance of training all health personnel, as well as the patients themselves, so that they are aware of the toxicities and psychosocial problems that may appear. “Information is the antidote to psychological discomfort,” she commented. And hand in hand with these needs, the role of the Psychooncology. Both Dr. Brozos and Dr. Pérez-Fidalgo claimed the need to have these consultations in one hundred percent of the centers and with adequate resources, since in those where they are available they are underfunded. “The health system should assume this need,” commented Dr. Fidalgo, who also recalled that Psycho-oncology does not have a specific training plan.
Measurement of real needs
At the meeting, the need to measure the care process was highlighted on several occasions. “Are we doing a actual measurement of patient needsAre we asking ourselves what the current needs are or what they will be in the coming years to adapt to them or are we working on needs from 10 years ago? asked Dr. Ruth Vera. We have to demand more from ourselves in communication with patients, Dr. Pérez-Fidalgo stressed in this sense, highlighting the usefulness of patient reported outcome in monitoring quality of life, which changes over time or may be different depending on the circumstances of each patient. On the other hand, during the meeting, oncological forgetting was also addressed, a right that, commented the president of SEOM, is included in Royal Decree 5/2023, approved on June 28, 2023, but which is undeveloped and which has large gaps. The clinical document around which much of the meeting revolved will be released soon and it was also announced that the scientific society is working on others to address long survivors in special populations such as children and adolescents or geriatrics.