Primary care physicians play a major role in long-term care for colorectal cancer survivors. They act as a go-between among a patient's network of specialists while ensuring that basic screening and wellness benchmarks continue to be met.
While not new, it's a multifaceted job whose value is coming into greater focus. The American Cancer Society (ACS) highlighted this value in September with the release of its first-ever survivorship guidelines to help family doctors better manage colorectal cancer survivors.
Such coordination, though, isn't always easy.
"Once patients complete care for the cancer they've been taking care of, transitioning that care to other physicians can sometimes be difficult," says Elena Stoffel, M.D., an assistant professor of internal medicine at the University of Michigan Medical School and director of the Cancer Genetics Clinic at the U-M Rogel Cancer Center.
About 132,700 people were expected to be diagnosed with CRC colorectal cancer last year in 2015, according to the ACS, and the disease is the second leading cause of cancer deaths in the United States for men and women combined. The colon/rectum is also the second and third most common cancer site among male and female survivors, respectively.
With March serving as National Colorectal Cancer Awareness Month, Stoffel spoke about some of the new guidelines intended to help primary care doctors provide optimal care.
Communicate early and often
A patient's oncologist ought to provide a written follow-up plan to be shared among everyone involved in the individual's care. That, Stoffel says, can help primary care physicians as well as other specialists "have an idea of who's on the team and what the game plan is" after initial treatment ends.
Continue screenings and keep tabs
Primary care physicians also need to keep up with a patient's follow-up care. The ACS report's screening guidelines include a colonoscopy one year after surgery in most cases (followed, if clear, by subsequent ones at the three- and five-year marks); yearly CT scans for up to five years; and a physical exam every three to six months during the first two years.
Stoffel also urges physicians to ask about — and monitor — family health history to gauge cancer risks for the patients and their loved ones going forward.
Monitor side effects
Surgery, radiation and chemotherapy can leave a CRC survivor fatigued, in pain and dealing with potential issues such as diarrhea and sexual dysfunction. Doctors should refer to the patient's treatment summary for specific drugs and dosages to address the problems — and, if necessary, contact fellow clinicians on the written plan.
Be emotionally present
The emotional toil of cancer can leave some survivors depressed and in constant fear of a relapse. Physicians might guide patients toward support groups or therapy and always lend a sympathetic ear. Stoffel notes: "I often tell patients to not think about their cancer diagnosis on a daily basis. Let your doctors worry about that. Worry about taking care of yourself."
Encourage healthful habits
A big part of getting better — and reducing the chances of a new or returning cancer — is living better. "You want to make your body as healthy as possible," Stoffel says. ACS guidelines urge 150 minutes of weekly physical activity plus a low-fat diet rich in fruits, vegetables and whole grains. Limit alcohol and red meat; avoid tobacco.
In short, primary doctors play a key role in recovery, a role Stoffel likens to the quarterback on a football team.
"Patients very much like to have a physician who is their go-to person, someone who understands everything going on with them," she says, praising the content and motive of the ACS report. "The effort to consolidate and review the guidelines of what we should be doing gives primary care doctors a very specific game plan."