When Phil Thibault received the life-changing news at the age of 26 that he had testicular cancer, a hospital clinic provided him with comfort and stability.
Months later, after gruelling rounds of chemotherapy, he was recovering and his disease was in remission, but he discovered that he wasn’t psychologically ready to sever ties with the clinic that saw him through such a difficult time.
It turns out he didn’t have to worry. Once his treatment was over, Mr. Thibault, a professional translator who lives in Toronto, was transferred to an innovative program dedicated to caring for patients once they are cancer-free.
Doctors and nurses at the After Cancer Treatment Transition Clinic, run by Princess Margaret Hospital and Women’s College Hospital, walked Mr. Thibault, now 28, through a detailed review of the treatment and types of medication he received.
They also monitor, on a continuing basis, for any aches or pains that could signal a return of the disease and provide counselling and support to nurture the vulnerable psychological state common to many who have had cancer.
“They really take good care of their patients,” Mr. Thibault said. “It makes me feel safe.”
Programs such as the Toronto clinic are part of a major shift that is changing cancer care across North America. A growing number of hospitals and health-care organizations are becoming more understanding of the fact that cancer survivors continue to face challenges – such as overwhelming fatigue, anxiety, difficulty returning to work, fertility concerns and changes in brain function – and they are creating specialized programs to help them.
“It’s a life-changing moment when [patients] hear they have cancer,” said Margaret Fitch, chair of the Canadian Partnership Against Cancer’s cancer journey advisory group. “In that regard, then, life is never the same again.”
Many cancer patients may also feel “abandoned” by the health-care system and want a place to go to have their concerns addressed, said Nancy Payeur, a social worker with the B.C. Cancer Agency who facilitates Cancer Transitions, a cross-country program focusing on patients once they have finished treatment.
“We’re trying to help people to manage their anxiety,” she said.
However, post-treatment care also presents a unique set of challenges, including finding money, supporting the new programs and figuring out the best way to deliver the care.
In the past, many patients were often left on their own once they were declared cancer-free, save for some follow-up visits and checkups with their family doctor.
But as the number of survivors continues to increase, putting pressure on the limited resources of cancer clinics and family practices, the medical community has been forced to recognize the need for dedicated post-disease care.
“That’s the fundamental shift that’s happening really right now,” said Gillian Hawker, chief of medicine at Toronto’s Women’s College Hospital.
Patients who are part of transition-care programs receive medical and psychological support and learn how to manage the short- and longer-term effects of cancer.
One major challenge survivors face is reconnecting with a family doctor and communicating the cancer drugs or therapies they received. Under the transition-care program model, health professionals provide patients with a detailed medical history, which they can take to future appointments.
“I think this empowers patients, just knowing that they have this document that they could take along with them wherever they go,” said Velita Contiga, a certified oncology nurse who co-ordinates a support-based survivorship program at the Marvelle Koffler Breast Centre at Mount Sinai Hospital in Toronto.
Ruth Shernofsky, a 58-year-old breast-cancer survivor who has gone through the program, said she has benefited greatly from having access to continuing support. “It made me feel that I wasn’t just kicked out the door,” she said. “I just felt that … I’m cared for if I need anything.”
The Mount Sinai program aims to arm patients with knowledge about proper nutrition, long-term effects of the disease and where to go for additional emotional and psychological support.
Dr. Hawker said that program is different than the one offered by Princess Margaret and Women’s College and highlights the fact that organizations have different approaches to “survivorship.”
Therein lies a major issue: There is no clear consensus on what the post-treatment programs should look like, what they should offer and how to ensure patients get the best treatment.
“I would say, at this point, survivorship care is rather spotty in terms of program delivery across the country,” said Dr. Fitch, who is also head of oncology nursing and co-director of the patient and family support program at the Odette Cancer Centre at Toronto’s Sunnybrook Health Sciences Centre.
The Canadian Partnership Against Cancer is hoping to address this by creating one of the world’s first national guidelines designed to give health professionals the best advice on what kind of physical and mental-health supports to offer cancer survivors and how transition-care programs should best operate.
“It’s quite forward-thinking,” Dr. Fitch said.
For patients like Mr. Thibault, who is considering writing a book with his wife about cancer and relationships, simply having support available meant being able to share his fears and anxieties on the road to recovery.
“It’s like a VIP club,” he said. “It’s just so nice to know I can talk to people.”