Cancer survivor guidelines not always followed, researcher finds

Researcher Marian Luctkar-Flude (PhD candidate, School of Nursing) has found that a majority of primary care providers surveyed are not routinely following many of the care guidelines for breast cancer survivors. The main guidelines not being implemented include screening for common survivorship problems such as fatigue, distress and sexual dysfunction.

"This research is significant as cancer care centres are now discharging many breast cancer survivors back to primary care within one to two years of their diagnosis when, in the past, they used to care for these women for five years before discharging them to primary care for follow-up," explains Ms.Luctkar-Flude.

According to Ms. Luctkar-Flude's research, there are many reasons care guidelines are not being implemented; however, one of the main barriers is that many primary care providers are simply not aware of the guidelines including recommendations for fatigue screening, distress screening and exercise.

"It's challenging for primary care providers to keep up to date on the new guidelines for all the health problems they deal with," she says. "It's helpful if the public and cancer survivors are also aware of the guidelines so that they can prompt discussions about some of the issues and make sure surveillance tests and exams are completed."

There are four components to the care guidelines, including:

• Prevention of recurrent and new cancers and late effects of cancer.
• Surveillance for recurrent or new cancers and assessment of physical and psychosocial late effects.
• Intervention for long-term effects of cancer.
• Coordination between primary care providers and specialists.

Primary care providers reported routinely implementing approximately half of the key guideline recommendations with breast cancer survivors in their practices. Knowledge and practice gaps were highest for recommendations related to screening and managing long-term effects such as fatigue and distress.

"The goal of my research is to support primary care providers and make them aware of the need to address all of these components with cancer survivors," Luctkar-Flude says. "Primary care providers are ideally positioned to provide comprehensive survivorship care that could significantly impact the quality of life of breast cancer survivors."

The research was published in the November issue of Canadian Family Physician.