Renewed focus on GP involvement with childhood cancer survivors

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16 October 2018
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Lachlan Gilbert

Better communication is needed between primary and tertiary healthcare providers treating children with cancer to enable GPs to provide survivors with the best follow-up care in adulthood.

General Practitioners are willing, but need greater support, to provide follow-up care to survivors of childhood cancer, a recent UNSW-led study has found.

Researchers interviewed 120 adult survivors of childhood cancer and parents of young survivors under 16, as well as 51 General Practitioners (GPs) to assess attitudes towards ongoing health care following recovery from the initial illness.

The authors found that while two-thirds of survivors had visited their GP for cancer-related care since finishing treatment, only just over half of the patients had high confidence in their family doctor’s ability to deliver their survivorship care. Those with low confidence felt that GPs were less connected to their cancer experience.

And while all GPs reported being comfortable caring for survivors of adult cancers, they indicated feeling less comfortable caring for childhood survivors.

UNSW Post-doctoral Research Fellow Christina Signorelli said GPs could feel more at home treating young cancer patients if they were kept involved in the treatment and early survivorship stages by cancer specialists, “so that survivors are more comfortable transitioning to primary care after hospital care ceases”.

“One way to achieve this is through better communication between primary and tertiary care providers, although how best to achieve this is yet to be determined” Dr Signorelli said.

“Patient care plans and patient-held records can facilitate such communication, by containing information about survivors’ treatment and medical history, as well as a clear plan for the surveillance needed to detect and manage long-term health risks.”

There are few survivorship clinics across Australia, located in primarily capital cities, which are under increasing pressure from recent improvements in survival rates. Dr Signorelli believes that while survivors may prefer hospital-based survivorship care, this is not a sustainable long-term option.

“For low-risk survivors, GP-led survivorship care offers a more sustainable, accessible and holistic alternative to hospital-based care,” she said.

But if almost half of the surveyed childhood cancer survivors had low confidence in seeing a GP for ongoing care, and GPs themselves aren’t entirely comfortable treating children with cancer, there is a task ahead to change perceptions and behaviours. Dr Signorelli says engagement with patients and their families is key.

“Moving forward, we need to encourage engagement with survivors to find a regular GP that they trust,” she says.

“Engagement in primary care is important as it promotes holistic care and greater continuity of care in the decades of life after cancer.”

To illustrate the importance of this point, Dr Signorelli pointed to two recently published studies showing improved outcomes in survivors who are engaged in follow-up care,  and decreased mortality with greater continuity of care.  

“I think creating a partnership between primary and tertiary care are critical steps towards ensuring survivors are treated to this more-consistent care across their cancer journey; from diagnosis, into early and long-term survivorship,” she said.

Dr Signorelli believes the changes needed in behaviour and thinking on this issue by tertiary and primary health providers can flow down to the families of young cancer sufferers who would have renewed confidence in receiving follow-up care from GPs after specialist treatment.

“I would see this change in practice perhaps filtering through national or even international guidelines for this population, given the complexity of their care, which of course would be reinforced through training,” she says.

“Ultimately, I think GPs are willing to assume responsibility for the care of childhood cancer survivors, but need the right support in order to do so.”

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