Cancer Survivorship Care

Skolarus and Hawley alerted us to the large numbers of prostate cancer survivors in the VA.¹ Prostate cancer is the most common male cancer. Many are cured, and those not cured generally have a long survival. There are adverse effects (AEs) to the curative procedures, including erectile dysfunction, urinary incontinence, and proctitis after radiation therapy. All those AEs require patients to seek professional attention over many years from their primary care providers (PCPs) and their oncologist/urologist. But fulfilling survivors' needs goes beyond those doctors who can effectively address physical impairments.

According to the Institute of Medicine, hospital discharge requires not only a warm goodbye, but also a written document that includes in lay terms the precise cancer and the precise treatment(s).² This care plan must include a shared recognition of possible recurrence, how that might be detected early, and a list of recommended periodic tests (mammogram, PSA, etc). The plans should serve to lessen the anxiety and may suggest sources of support, of job finding, of retraining. It may also mention the remarkable collaborative role local American Cancer Society units have undertaken serving cancer survivors.

The one social worker at our VA clinic provides support to all survivors in a weekly open get-together. Psychologists, pharmacists, and oncologists may attend these meetings. The focus is on allowing patients to express concerns and share personal issues, such as incontinence and sexual dysfunction, in a safe and understanding environment. Veterans do not easily share deep feelings or ask for help. But here they provide various interventions, learn of multiple community possibilities, discuss loneliness, share their unfulfilled social needs, and express the stress of possible recurrences.

The PCPs and oncologist/urologist identified in the Skolarus/Hawley article are needed for possibly correcting physical impairments, but there are others, such as social workers, American Cancer Society teams, psychologists, etc, who are better at helping patients adjust to their impairments.

Everett Shocket, MD, MSurg
Jennifer Feeney, LCSW
Bay Pines VAMC, Sarasota Florida

Editor's Note: For guidance on creating cancer survivorship plans, visit FedPrac.com/AVAHO.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.