In this edition of the LOC Journal, we talk to GPs Dr Dan Brook and Dr Michael Harding; key collaborators in the post-treatment ‘Moving On’ course that Living Well runs for LOC patients. Alongside specialist Oncologists, they share their insights with patients on stepping away from specialist care, to primary care provided by GPs.
The Living Well programme provides supportive care every step of the way, from how to cope with a diagnosis of cancer to managing the side-effects of treatment and lifestyle advice.
This support includes advice on how to move away from specialist care after treatment finishes, and how to re-engage with your GP.
“ The importance of good communication and co-ordination between the various health professionals and for patients to be aware of who would do what, post treatment is key,” explains Living Well’s Programme Director, Dr Michelle Kohn. “At the end of treatment, in the recovery and rehabilitation period, and beyond, at Living Well, we focus on the importance of establishing or re-establishing contact with GPs. The relationship is ongoing and involves family members too. Nurturing this, with a view to a long fruitful bond, is the encouragement that we give. We urge patients to be proactive.”
The number of people living with cancer is expected to rise in the coming years as treatments improve, and the population is living longer. The concept of cancer survivorship (living with, and beyond, cancer), is a pertinent topic in the medical community and there is growing recognition of the importance of primary care provided by GPs in ensuring the physical, psychological and practical needs of cancer are met.
This includes everything from screening for other cancers, looking out for short and longer-term effects of treatment, late effects which may occur some time afterwards, and advice on healthy lifestyles, and social care and psychological support.
“I have attended conferences recently that have explored cancer survivorship and the importance of general practice involvement,” comments Dr Kohn. “Both the Harvard survivorship conference, in November last year, and ASCO’s inaugural dedicated cancer survivorship symposium in San Francisco, in January, highlighted the role of general practice in enabling ongoing care.”
Dr Kohn was invited to present at the Macmillan Cancer Support/Christie conference in March on ‘Changing prospects for cancer – a good survival’, and discussed how we include the role of the GP during and after treatment and the guidance we offer, to ensure the ongoing needs of our patients and their families are met.
Going through cancer treatment can be a long journey, during which you might form a close bond with your Oncologist and their specialist team, who you see often and turn to for advice and support. While you are having treatment for cancer, it’s possible that you might lose touch with your GP, or perhaps you did not have a relationship before you were diagnosed.
As Dr Dan Brook, an NHS GP as well as a private GP at The Brook Surgery, explains:
“During that period of time, particularly at the LOC where there are such excellent Oncologists, patients veer away from primary care and their GPs as they have direct access to their Consultant Oncologist and the team around them. And appropriately, they’re looked after very closely by those people.”
Dr Michael Harding, GP at the Princess Grace Hospital, believes it can be a challenging experience to consider issues that arise when there is less access to the specialist team.
“When new symptoms arise there is a heightened awareness of what could possibly be wrong and where does one turn?” he comments.
While Dr Harding and Dr Brook remain involved in their patients’ care while they are having cancer treatment, if you have lost touch, they believe re-engaging with your GP is important at that time.
“Patients have to restore their confidence in their own health; they need to share that experience with their GP and the practitioner’s team, so that they can get back into a sense of relinquishing the need and the dependence on their specialist”, comments Dr Harding.
Dr Brook agrees:
“For a lot of people, their GP hasn’t really been a part of the journey. Yet they are a cornerstone of the future.”
The key role of GPs
After treatment for cancer, your GP becomes ever more important as general medical issues arise.
“Just because somebody’s had cancer they’re still going to fall and twist their knees, they’re still going to have chest infections, they’re still going to be at risk of cardiovascular disease,” says Dr Brook. “The Oncologists are not experts in those areas so people need to re-engage with their GPs who have expertise as a diagnostician. They’re not going to know nearly as much cancer-related medicine as an Oncologist, but they’re going to know much more about most other areas of medicine, and be experienced in investigating patients who may need recurrence of malignancy excluded.”
Your GP can also become a vital source of support as you start to rebuild your life. They can help you in all aspects of recovery, whether it be physical, such as putting on weight and getting fit again, or psychological, such as building up the confidence to go back to work.
“People going through chemotherapy don’t really think about how much it can affect their lives and can come out on the other side feeling like a different person,” explains Dr Brook. “Going back to all those things that were very normal and very easy before the cancer can be very difficult. I’d hope that most GPs see it as part of their role to support people with that. Everybody’s different and hopefully a good GP will be able to manage all those different problems equally well with each of their patients.”
So a good relationship with your GP is vital – but how do you go about building this?
Dr Harding believes a good way to get back in touch with your GP at the end of cancer treatment is to have a health “MOT”.
“ A check-up is a very good way for people to re-engage with their local practice so they can feel confident there is a place they can visit for a variety of different issues. Other parts of the body can be influenced by the treatment they’ve received, or other parts of the body might be neglected. It’s also an opportunity to be able to describe what they have been through.”
Dr Brook stresses that patients should take responsibility for re-building their relationship with their GP. He advises booking an appointment to go in to the surgery to share your experience.
“Some people might need to make an appointment every four or five weeks for the first few months after chemotherapy just to re-engage and to build a rapport and to trouble-shoot little things. I think most GPs understand that it’s part of moving on and part of having the confidence medically to get on with your life knowing that there’s somebody there who knows you and has got your back when there’s a problem.”
In fact, Dr Brook believes everyone coming out of cancer should have such a relationship with their GP:
“If you don’t have a GP like that, or don’t think you can have that relationship with them, then you need to find a new one.”
Not everybody has access to private primary care and in these circumstances it can be difficult to see your GP if it’s a busy practice. However, there are ways to ensure you still get heard.
If you find you are unable to get appointments with your GP for example, Dr Brook’s advice is to leave a message so they can call you back.
“ When the receptionist is doing their job and it might seem, being a bit of a wall, don’t be afraid to tell them you’ve had cancer and that you need to see your doctor. Sometimes patients need to go further to make sure they get heard and they get seen.”
Dr Brook cites this as further justification for taking responsibility to building a strong relationship with your GP.
“ If you’re expecting an unfamiliar GP to drop everything, realistically it’s unlikely to happen but if on the other hand, you’ve made an effort to build a personal relationship, they’re much more likely to go that extra mile to help you. I think GPs are legitimately the sort of people who want to be able to offer that service and when somebody has had cancer, they do want to help.”
Over the last few years, the Living Well programme has evolved to meet the needs of patients and to support professionals. And the guidance patients have received has had a notable impact. They reportedly feel more resolute to take control, and have followed up the suggestions offered by the expert speakers.
One recent patient commented: “I hadn’t considered the importance of having a good relationship with my GP as I was so focussed on my cancer, but after attending the Moving On course I immediately went in to see my GP for a check-up. I really valued the opportunity to catch up and talk about the support my GP can give me in getting my life back on track.”
Our six-week ‘Moving On’ course starts in May. If you would like to attend, or have any questions about the Living Well programme, please contact Karrol Aldous, the Living Well Co-ordinator and Patient Admin Lead:
Tel: 020 7317 2590