The good news about cancer is that there are increasing numbers of people surviving after treatment, thanks to advancements in medicine and early detection through screening. As of January 1, approximately 18.6 million people in the United States had a history of cancer treatment, a number expected to surpass 22 million by 2035, according to a new report from the American Cancer Society. This surge in survivors presents a significant challenge for primary care clinicians, who will increasingly be tasked with managing the long-term aftermath of cancer treatment.
While the report excludes most in situ carcinoma and basal cell or squamous cell skin cancers, it underscores the growing demand on primary care providers. Some cancers are appearing more frequently in younger populations, potentially linked to sedentary lifestyles and poor dietary habits. Research indicates that excess body weight may contribute to the global rise in early-onset breast, pancreatic, colorectal, and kidney cancers.
Advancements in Cancer Treatment
Cancer treatments have undergone radical transformations. While traditional chemotherapies that target fast-growing cells remain prevalent, new classes of drugs are emerging, often with limited data on their long-term safety and efficacy. These include immune checkpoint inhibitors, chimeric antigen receptor T-cell therapies, and novel monoclonal antibodies.
“It’s an exploding field,” said Kimberly S. Peairs, MD, vice chair for clinical affairs at Johns Hopkins School of Medicine in Baltimore. Despite these advancements, there has been limited focus in U.S. medicine on the transition of patients back to primary care after treatment. Recognizing this gap, Peairs founded the Primary Care for Cancer Survivors Program in 2015, which has become a model for physicians aiming to bridge these care gaps.
Empowering Survivors
Ilana Yurkiewicz, MD, of Stanford University School of Medicine, sought guidance from Peairs to create a cohesive approach to post-cancer care. Yurkiewicz collaborates with Natasha Steele, MD, a former lymphoma patient, to address the challenges survivors face when transitioning from oncology-focused care to self-managed health.
“During cancer treatment, patients have to put their lives in the hands of their oncologists and trust they are safe,” Steele said. “But survivorship is a paradigm shift where we’re really trying to empower patients with information and skills to manage some of their health risks longitudinally, and this can be challenging for a lot of reasons.”
Primary Care’s Evolving Role
The evolving landscape of cancer treatment and survivorship presents an opportunity for primary care clinicians to engage in one of the most rapidly advancing fields of medicine. The National Comprehensive Cancer Network (NCCN) updated its guidelines 241 times last year, providing a wealth of resources for clinicians. Tools like UpToDate and continuing medical education courses are invaluable for primary care providers navigating this complex terrain.
“We’re not asking primary care people to be oncologists,” Peairs emphasized. Instead, they can help patients adjust to their “new normal” post-treatment life. Below are three strategies for primary care clinicians, based on interviews with experts in oncology and survivorship.
1. Preventing Recurrence and Future Cancers
Primary care clinicians play a crucial role in communicating preventive measures to patients who may struggle with follow-up care. Kathleen N. Mueller, MD, system director for integrative medicine and cancer survivorship at Nuvance Health, stresses the importance of conveying these messages effectively.
“When you’re undergoing treatment for cancer, it’s really difficult to process information,” Mueller said. “It is an overwhelming diagnosis.”
Crystal S. Denlinger, MD, CEO of NCCN, advises breaking down preventive discussions into manageable parts across multiple visits. This approach allows patients to absorb critical information without feeling overwhelmed.
2. Providing Emotional Support
Creating a “safe space” for patients to express their feelings is vital, according to Steele. Many survivors do not feel like their pre-cancer selves, which can be distressing. Primary care providers are well-positioned to address post-treatment anxiety and the fear of recurrence.
“Now they’re returning back to the life that they had before they had cancer,” Denlinger noted. “This may be a time where primary care providers are an important resource to address some of this post-treatment anxiety.”
Research from the Johns Hopkins Primary Care for Cancer Survivors Program highlights the emotional needs of patients, with many expressing fears of recurrence and challenges in managing emotions like anger, anxiety, and depression.
3. Monitoring Changing Risks
Denlinger emphasizes the importance of staying updated on patients’ family histories and screening guidelines. New genetic tests, such as those for pancreatic cancer risks, may become relevant for certain patients over time.
In conclusion, as cancer survivorship rates continue to rise, primary care clinicians are increasingly essential in supporting patients through their post-treatment journeys. By focusing on prevention, emotional support, and risk monitoring, they can help survivors navigate their new normal with confidence and care.
