Thursday, April 3, 2014

New Guidelines for Life after Cancer

The Spring issue of Cure Magazine has an article on the new guidelines for life after cancer from the National Comprehensive Cancer Network. Sometimes I just want to say 'its about time'.

The article provides a nice overview and is a worthy read. But I do feel it is way late. Why does the medical profession feel so vertical? In the days of personalized medicine, isn't the patient's entire body supposed to be of concern? Each specialist only seems to deal with their little focus and not that of the entire patient.

A cancer diagnosis is not the same as a chicken pox diagnosis and leaves a life long impact. The new guidelines show a new way of thinking. If no one asks about it, how will it become known as an issue?

'To develop the new guidelines, the NCCN engaged experts in oncology from throughout the country. During the course of a year, they split into working groups—one for pain, for example, another for sleep issues—and reviewed the scientific literature on how to assess survivors’ problems and intervene in a meaningful way. Focus areas included:
  • Anxiety and depression
  • Cognitive dysfunction
  • Exercise
  • Fatigue
  • Immunizations and prevention of infections
  • Pain
  • Sexual dysfunction
  • Sleep disorders
The guidelines were then developed to give oncologists, primary care doctors, nurses, social workers and other healthcare providers an easy-to-follow structure. At the first level, providers might consider asking a few simple questions.

To check for anxiety and depression, for example, the provider might ask:
  • Do you often feel nervous or do you worry?
  • Do you often feel sad or depressed?
  • Have you lost interest in things you used to enjoy?'
It seems almost too logical and clearly in the category of "why didn't we think of this before?"

There is a lot of reliance on the primary care physician who is supposed to care about the whole patient. At this point, I see my primary care annually and see all the specialists more frequently. While they focus on their part, its only when I get to my PCP, that my whole body and being gets discussed. And last year due to scheduling issues, I saw her nurse practitioner, who is nice, but not the same. I do like having my annual physical with my PCP.

But back to the new guidelines. I think its time for me to start making a list of my issues that relate to the focus areas to make sure I am prepared for my appointment... In July.

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