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A helping hand for cancer patients and their primary care providers

Once active treatment is complete, it is appropriate for followup care to be transferred to a patient’s family doctor or primary care provider, however this transition can be challenging for both patients and providers. New supports being put in place by Cancer Care Nova Scotia are helping to make the shift from specialist to primary care provider more seamless and effective.

That project, now in the start-up phase, is called CRISP, which stands for Colorectal Cancer Implementing Survivorship Care Plans. It is intended to help empower both patients and health professionals.

“For many cancer survivors,follow-up care is straightforward and can Supporting patientsbe provided by a patient’s primary care provider,” says Marianne Arab, CCNS’s Manager of Supportive Care. “However, primary care providers have told us they need support to provide their patients with the best possible care. CRISP is how we’re responding to this request.”

As a starting point, CCNS is focusing on colorectal cancer patients and their primary care providers. “We are working with colorectal cancer patients initially but we will take what we learn and create long-term follow-up care plans for other types of cancer as well,” explains Marianne.

Research conducted by Cancer Care Nova Scotia indicated that primary care providers  want comprehensive guidelines and a clear transition of care plan to support them in providing followup care to their patients. As a result of this feedback, CCNS’s Gastro-Intestinal Cancer Site Team has developed evidence-based guidelines for long term follow up care for colorectal cancer patients who have completed treatment.

Primary care providers will receive these guidelines as a part of a personalized transfer of care note which summarizes the patient’s cancer care. “These materials are clear and easy to understand,” notes Marianne. Use of this transfer of care note will begin this month at the Capital Health Cancer Care Program.  “As we implement this program, we will be seeking ongoing feedback from primary care providers to ensure we are meeting their needs.”

“Our overall objective,” she adds, “is to lay the foundation for long-term follow-up care plans as a standard of care for cancer patients in Nova Scotia.”

Patients are also a focus of CRISP. “Patient education and information is central to this program,” says Marianne.

Each patient will receive a package including a summary of their care and the long term follow-up care table as well as information on symptoms to watch for which may point to a recurrence, a list of what is normal and what isn’t, other screening recommendations, and tips for healthy living.

 “Our hope is that patients will feel more empowered and informed when armed with this information,” says Marianne. “It is very comprehensive.”

“It is also potentially life-saving. “With colorectal cancer, research has shown that earlier detection of recurrences does lead to better outcomes.  For example, metastatic colorectal cancer disease can be cured through resection and 40 percent of successfully resected patients are alive 5 years later.”

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