October 6, 2001
FPs play important role after patient is diagnosed with cancer
BY DENNIS CONNAUGHTON
People surviving cancer and their families rely on family physicians for critical health services, family physician Mary Elizabeth Roth, M.D., said Thursday in a mini-course. She is vice president for medical affairs at Sacred Heart Hospital in Allentown, Pa.
Roth described for attendees the skills they need in supporting long-term survival or a dignified end to life for patients who have been diagnosed with cancer.
Roth said providing continuity of care for the patient and family dealing with cancer includes:
- giving patients reliable information and sources of information about their particular cancer,
- helping patients make informed choices about therapy,
- managing the patient's physical and psychological reactions to therapy, and
- treating chronic diseases related to cancer.
WATCH YOUR LANGUAGE
"You should talk about a cancer survivor or person dealing with cancer rather than a cancer patient or cancer victim," said Roth.
People dealing with cancer need to understand the vocabulary of treatment outcomes, including remission, long-term survival, palliation, supportive care and hospice care, she said.
Among the common health problems cancer survivors face are radiation-related proctitis, malnutrition and dehydration, leukopenia, pneumonia, skin burns from radiation therapy, lymphademia, diarrhea, tuberculosis, gastroesophageal reflux disease, fatigue that may become chronic, anorexia, acute and chronic pain, depression and anxiety.
Family physicians not only need to diagnose and treat all these health problems, but must also provide routine health maintenance strategies, such as diet counseling, immunizations for hepatitis B and influenza, exercise programs and routine screening exams, Roth said.
"Family physicians must manage the non-cancer health and disease issues in light of the patient's cancer treatment plan," she said. "Long-term health problems, such as cardiomyopathy, osteoporosis, malnutrition and short bowel syndrome, require chronic medical care."
HEALTH PLANNING
Roth said every cancer survivor needs a health maintenance and disease prevention plan that takes into account the risk of recurrence and the late effects of cancer therapy, such as renal toxicity, pulmonary fibrosis, cerebellar ataxia, peripheral neuropathy, deafness, cataracts and myopathy.
"Persons who survive cancer are also subject to behavioral problems after successful cancer treatment, such as risk taking, cigarette smoking, alcoholic binges and denial of symptoms," she said. People dealing with cancer experience fear and anxiety about losing control of their lives, families, finances and emotions. They also feel anger and frustration. Many have issues surrounding sexuality and sexual function after being treated for cancer. These patients need education and counseling from family physicians.
Finally, patients and their families need the help and support of family physicians in facing death, Roth said. "The family physician must assure the patient he or she will not be abandoned. Oncologists often withdraw when therapy is no longer effective, and the patient may feel dropped."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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