Colorectal cancer survivors turn to NPs for follow-up, and co-ordination of after-treatment care
Margaret* was worried. Two years after she underwent surgery to treat colorectal cancer, a routine follow-up CT scan indicated the disease may have returned – only this time, to her liver.
Anxious, she called Clea Lang, one of two nurse practitioners leading the Colorectal Cancer Survivorship Program (CCSP), the first program of its kind in Canada to work with survivors. CCSP moves cancer care out of the oncology setting and into primary care, Lang explains.
Margaret’s test results did not concern the seasoned NP, but she sent her nervous patient for an ultrasound. Less than 12 hours later, she called Margaret to share the good news: there was nothing to worry about. “She had a low risk cancer to begin with, but cancer is scary,” says Lang. “These little moments of being able to put people at ease (are) amazing. This is why we do the work we do.”
Lang and NP colleague Jennifer Tiberio operate the program out of the North York Family Health Team (NYFHT) offices, providing similar one-on-one care to almost 100 patients from Toronto’s North York General Hospital (NYGH). The program began in April and is only available to NYGH patients who have completed treatment at the hospital.
Lang and Tiberio perform follow-up physical exams. Typically, if colorectal cancer recurs, it can be found in a patient’s liver, lungs or colon within five years of treatment. The nurses emphasize the importance of healthy living in each 30-minute appointment, and screen patients for depression and anxiety. Women are reminded to schedule routine pap smears and mammograms. Patients are monitored for five years, and all of their health-care providers – including the family doctor, and members of the cancer care team – receive a consult letter after each visit to CCSP. That way, “everyone’s in the loop,” says Lang.
After seeing Lang or Tiberio, patients are booked for an appointment with a social worker (who also works out of the NYFHT) to address psychosocial, psychological or social needs.
Before CCSP launched last spring, colorectal cancer patients at NYGH would have seen anywhere from one to three different health-care providers after their treatment wrapped up , such as oncologists and surgeons, in addition to their primary care provider and/or other specialists.
“There was no co-ordination (between these visits),” explains Lang. The risk was that people would have double imaging or blood work, which could lead to extra appointments and confusion. “Here, what we’re doing is co-ordinating (everything): one place, one person, one visit,” she explains.
“We take a holistic approach,” she adds. “We (don’t just focus) on cancer.” The nurses ask their patients question such as: are you able to get to your appointments? Are you feeling anxious? Do you understand your diagnosis? “We have time to explain to people what has happened and what is going to happen. I think patients really value that,” says Lang.
Oncologists and surgeons also appreciate the care Lang and Tiberio provide to their clients, but Lang admits this wasn’t always the case. Many had never worked with NPs before and didn’t understand the role. “We got a lot of ‘let’s just keep it simple for the nurse practitioners,’” she recalls of her colleagues’ initial unfamiliarity when it comes to NPs’ knowledge, skills and decision-making capabilities. “Now, they praise us at every opportunity.” Oncologists and surgeons are now able to see patients who have been newly diagnosed with cancer, while the nurses at CCSP monitor those who have finished their treatment, Lang adds.
Though still in its infancy, CCSP is tracking survivorship data that Lang hopes will help to create evidence-based guidelines for Cancer Care Ontario. According to the Canadian Cancer Society, more than 23,000 Canadians will be diagnosed with colorectal cancer this year. The five-year survival rate for the disease is about 63 per cent. Talks have started with Newmarket’s Southlake Regional Health Centre, which is looking at developing a similar program for breast cancer survivors.
“Even if we’re just sharing what we’ve built, we can improve survivorship care elsewhere,” says Lang.
* Not the person's real name.