Many cancer survivors are not getting the follow-up care they want or even the care they need.
According to a study titled, “Adult Cancer Survivors Discuss Follow-up in Primary Care,” published in the National Center for Biotechnology Information, 52% of participants expressed that they strongly prefer to receive their follow-up care from a cancer specialist. They felt that primary care specialists had (1) a lack of cancer expertise, (2) limited to no involvement with their original cancer care, and (3) a lack of care continuity. These were the three main factors attributed to a barrier in the primary care physician’s engagement in the cancer survivors’ follow-up care.
These findings were reinforced by the fact that 79% of the participants felt that “cancer follow-up care requires a specialist’s knowledge of cancer that primary care physicians do not possess” and 43% felt that their primary care physicians were not engaged in their cancer care.
“Several described their physicians as not being attuned to the needs of cancer survivors. In particular, they were concerned that primary care physicians do not consider a patient’s status as a cancer survivor in their diagnostic or treatment decisions… Participants described their primary care physicians as ‘ignoring’ cancer-related issues because either they presume the patient is under oncologic care or they defer and refer cancer-related questions back to oncologists.”
In a study entitled, “What are cancer survivors’ needs and how well are they being met?” published in the National Library of Medicine. Researchers found that about 30% of the 1,668 survivors surveyed had at least one unmet emotional, social, or spiritual need. About half of that, just 14.4%, had at least one unmet economic or legal need. The most commonly identified individual unmet needs were “help reduce stress” (14.8%) and “information about possible after-effects of treatment” (14.4%).
The National Institute of Health had a cancer survivors conference where they discussed how after 5 years of remission, 55% of patients aren’t being monitored by a medical care provider. They surveyed female survivors and found that their biggest complaint was vaginal issues (dryness, low libido, etc.) Then they asked doctors how they are responding to the needs of cancer survivors, only 5% responded to the question to say that they usually give patients a brochure, some lube, and possibly a referral. It seems like oncologists and surgeons are busy killing cancer cells, while PCPs are expected to follow up but don’t provide the knowledge/resources the patients need. That’s where we come in.
At our office, we continue to all of our patients, including the cancer survivors, yearly. We are very successful at finding solutions for our patients’ concerns and symptoms. We believe that with the right treatment(s), we can prevent unnecessary suffering in almost all of our patients. It bothers us that there are so many survivors out there struggling when as doctors we can and should help them.
A large percentage of vaginal issues that these survivors are experiencing can be addressed in our office with an estrogen therapy regime and/or laser vaginal rejuvenation treatments like the Mona Lisa Touch. We offer a discounted rate for cancer survivors who are interested in getting the Mona Lisa Touch procedure because of the positive impact we know it can have on patient’s lives.
There are specialized concerns and treatment options for breast cancer survivors. Estrogen therapy is discouraged in breast cancer survivors because of the increased risk of remission it causes so other treatment options will need to be explored.
The survival rate for breast cancer is 99% over 5-years and 84% over 10-years. These are great survival rates, but many patients are terrified when they are diagnosed with breast cancer that their diagnosis will be fatal. This mindset makes them happy to receive treatment because it increases their chances of survival. Many patients don’t want to complain about side effects, like the impact on their sex life, considering the treatment saved them. Their partners don’t want to complain because they want to be supportive of their wife who is recovering from cancer. These factors cause many side effects they are experiencing to be, “swept under the rug.” We want our patients to know that there are resources to help them and they don’t have to suffer in silence.
Another problem many cancer survivors face is depression. When a patient comes into our office experiencing symptoms of depression, we first aim to categorize which type of depression they are experiencing based on the chemical imbalances in the brain. If a patient is being treated for depression at our office, there is a science-based reason why we choose certain medications. If there is a lack of serotonin, they may need a serotonin booster unless they are taking progesterone, then we can evaluate if they are potentially taking too much progesterone because that can cause a serotonin deficiency.
We want to determine if there is a hormone, thyroid, vitamin D, or grieving process issue that we can help with. Unlike primary care providers, antidepressants are seen as a last resort method of treatment. This is because we have found that (1) patients don’t usually want antidepressants and (2) after we go through the process of ruling everything else out, most patients are more open to taking antidepressants if necessary because they see the need for it.
If we determine that the patient does need antidepressants and we find a medication that works for them with no side effects, they need to stay on the medication for at least six months because if they don’t there’s a 65% chance of depression relapse. Once we find a successful antidepressant, we schedule an appointment for eight months out and we will slowly start to wean them off the medication. If their symptoms get worse when decreasing the dose, we will know the patient will need to stay on the medication a little longer. We also don’t take patients off the medication if they are going through a stressful life event like a divorce or finals.
Many patients also need to work through the grieving process surrounding their cancer and work through their fear of remission. For more information on depression and the grieving process check out our Youtube channel.
We all know someone who has had cancer, please share this with them to let them know that there is help available and they don’t have to suffer. We have helped all types of cancer patients (Breast, Colon, Uterine, Ovarian, etc.) get the relief that they need. In fact, Dr. Davis just did a presentation at the Cancer Center where he discussed many of the things we mentioned in this blog.
If you are a cancer survivor who wants additional resources or if you’re concerned that you may have a gynecological problem that is unresolved, please contact Mangrove Women’s Health at (530) 345-0064, Ext 281 to set up an appointment.