New guide to support GPs ease cancer recurrence anxiety

News

Touted as a ‘world-first fear of cancer recurrence clinical pathway’, a new step-by-step guide has been created to walk patients and healthcare professionals through best-practice care.

 

Led by researchers from the Daffodil Centre, the three-step plan was created with the input of almost 100 medical experts, with the aim of identifying and supporting those experiencing fear.

 

According to the research, around 60% of cancer survivors experience moderate to severe anxiety that their cancer will return or worsen.

 

Many of these patients reported being left on their own to navigate feelings that their fears would be ‘considered frivolous’ or they should be ‘feeling lucky to have survived’.

 

To address these widespread concerns, the three-steps of the clinical pathway are: 

1. Screening individual patients and asking about their worries related to cancer recurrence
2. Gauging the severity of their concerns and exploring treatment options
3. Provide staged and tailored support through normalising concerns, offering information on risks and symptoms, and offering support online or treatment from a mental health specialist

For cancer patient Victoria Turner, this ongoing anxiety is something she knows all too well.
 
‘I have late-stage ovarian cancer with a 70–90% chance of recurrence, but this was not discussed with me, and no psychological support was offered,’ she said.
 
‘I am a regional patient, so I had to access an oncology psychologist at my own expense, which also required significant travel.
 
‘I would have appreciated an open discussion about the possibility of my cancer recurring and information about strategies to deal with the fear and anxiety.’
 
Chair of the RACGP Expert Committee – Quality Care Professor Mark Morgan told newsGP this fear is a ‘critically important issue’ that can significantly impact a person’s wellbeing.
 
He said patients should be encouraged to maintain contact with their GP even in the midst of oncology treatment programs.
 
‘This clinical pathway was the outcome of collected Australian expert opinion using the Delphi consensus process, the resultant pathway has components that make a lot of sense,’ Professor Morgan said.
 
‘I hope there will be some evaluation of applying the pathway for cancer survivors so we can continue to refine and improve the process.
 
‘There was no consensus on when to screen cancer survivors for fear of cancer returning – GPs have confidence and expertise in sensitively exploring patient concerns when it seems appropriate, and the patient is open to the conversation.’
 
Professor Morgan was part of an RACGP team working on the college’s Cancer Survivorship Shared Care position statement with the aim of highlighting the role of general practice in offering patient-centred management and care.
 
The statement went on to call for a collaborative, shared-care cancer survivorship model between patients, their GP and the general practice team, specialist cancer services, other healthcare providers and required community services, as well as greater GP renumeration and upskilling.
 
However, it also points to specific barriers to providing shared care, such as time constraints, a lack of guidance for recommended timeframes for follow-up monitoring, workflow constraints, and generalists’ knowledge gaps.
 
Professor Morgan said similar fears often extend to patients who have survived other life-threatening illnesses, such as an acute coronary event, and that some of the same learnings from the Daffodil Centre could also apply in this setting.
 
But he said any care must be coordinated and communicated with the patient and all healthcare professionals.
 
‘There is an important role for clear communication between specialist teams and GPs so that necessary evidence-based monitoring for cancer recurrence is coordinated and neither undercooked nor excessive,’ Professor Morgan said.
 
Moving forward, the Daffodil Centre’s Senior Implementation Scientist, Associate Professor Ben Smith, said patient fears cannot be left unaddressed.
 
‘If we don’t address this issue now, it will continue to grow, potentially overwhelming a system that is already struggling to meet the demand for specialist mental health care,’ he said.
 
‘By implementing this plan, we will be able to respond to fears early and address them efficiently before reaching crisis point.’
 
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cancer cancer treatment clinical pathway mental health oncology