Consequences of Cancer and Treatment

Consequences of Cancer Toolkit

MacmillanImprovements in the diagnosis and treatment of cancer mean that more people are living longer after a cancer diagnosis, but not everyone is living well.

The consequences of treatment can include physical and psychological effects, such as chronic fatigue, sexual difficulties, mental health problems, pain and urinary or gastrointestinal problems. Certain cancer treatments also increase the risk of other serious long-term conditions such as heart disease, osteoporosis or a second primary cancer.

Macmillan Cancer Support estimate that at least 625,000 people in the UK experience long term health conditions caused by cancer or its treatment – to estimate prevalence amongst GP practice populations, this is the equivalent of about 15 patients per 1500 list size.

Who is the toolkit for?

The toolkit provides resources and information for primary care professionals to identify and manage the consequences of cancer treatment, and support patients to live well after a cancer diagnosis. It is designed to be used by any general practice in the UK, and is appropriate for everyone who provides or commissions services for people living with and beyond cancer.

Supporting patients after a cancer diagnosis

Primary care can contribute in many ways to improved outcomes and patient experience following a cancer diagnosis. These improvements can often be achieved through simple steps such as maintaining an up-to-date cancer register, being aware of potential consequences of treatment, and increasing knowledge of local services and support available.

Managing patients after cancer treatment

Cancer Care Review

The Cancer Care Review (CCR) is carried out by the GP practice within six months of a diagnosis of cancer. Continued annually, it helps the person affected by cancer to understand what information and support is available to them, and enables supported self-management.

The Macmillan primary care community has worked with the main GP IT system providers to develop cancer care review templates similar to those for other chronic disease to ensure consistency and quality of the review

Cancer recovery package

The Recovery Package is a combination of interventions which, when delivered together, can greatly improve outcomes and care coordination for people living with and beyond cancer, including better and earlier identification of consequences of treatment.

The Recovery Package was developed and tested by the National Cancer Survivorship Initiative (NCSI) - a partnership of Macmillan Cancer Support, Department of Health and NHS England - to help people living with a diagnosis of cancer to prepare for the future, and identify their individual concerns and support needs.

The Recovery Package comprises:
  • Cancer care review
  • Holistic needs assessment and care planning
  • Treatment summary
  • Health and wellbeing events

Further details on the Recovery Package interventions

Recovery Package Good Practice Guide

Identifying patients at risk of consequences of treatment

People whose symptoms arise years after their cancer treatment has ended are often no longer in follow-up with their oncology team. Their GP is likely to be their first point of contact and yet sometimes people can be reluctant to raise these problems, as they may seem embarrassing or trivial compared to their cancer. It is therefore important that patients at risk of consequences of treatment are proactively identified.

Use READ codes to identify patients at risk

Effective coding of both cancer diagnosis and treatment will ensure that everyone accessing health care records is fully informed of previous treatments, and can help to improve identification of patients at risk of late consequences. Consider using the codes for chemotherapy and radiotherapy for all patients who receive these treatments.

Potential consequences of treatment

These resources provide a summary of possible consequences of treatment and may be used as a reference.

Managing consequences of treatment

Early management of consequences of treatment can significantly improve outcomes for patients. Equally important is the establishment of referral pathways for complex cases.

Guides to managing common consequences of cancer treatment

Reference guides for managing specific consequences of cancer treatment have been produced by Macmillan, setting out key investigations, treatment options and advice on referrals.

Other useful guidance

Supporting self management - patient resources

Booklets for patients

A selection of free booklets produced by Macmillan, with links to websites containing other useful patient resources.

Macmillan toilet card

Cancer treatment can affect bowel and bladder function. This free card and key ring assists patients in gaining urgent access to a toilet when in public, by reducing the need for potentially embarrassing conversations.

Physical activity for cancer patients

Being physically active during and after cancer treatment can have multiple benefits for cancer patients including slowed disease progression, improved survival and reduced recurrence. Physical activity helps cancer patients maintain physical condition, can help improve psychological wellbeing and can reduce some consequences of treatment such as fatigue and swelling.

In the UK only 23% of cancer patients are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers an opportunity in which patients might be more receptive to lifestyle changes. Primary care professionals are well placed to offer physical activity advice and signpost into local support services. The following resources can help you support your patients to get and stay active at a level that suits them.


Patient information

Work and finance

Cancer often affects people’s ability to work and subsequently their finances may suffer. This can cause a huge amount of worry at an already distressing time. The following resources can support your conversations about work and finance with people affected by cancer and help you signpost them to further advice.

Training and appraisal

Training resources to help contribute toward CPD and revalidation requirements as part of reflective practice.

Supporting people with cancer in primary care

This module equals one hour toward your CPD, and contains a series of cases with questions to guide you through the topic of supporting people with cancer in primary care.

Revalidation toolkit

The below tools comprise a practical guide for GP appraisal and revalidation including self-assessment questions on cancer prevention, screening and cancer management. Use these guides to improve your practice’s performance in prevention and in the care of patients with cancer.

*Please note that the RCGP is phasing out the arbitrary doubling of "impact credits" with immediate effect, so that by 31st March 2016, they will no longer be applicable and they will have been replaced by the formula:

One CPD Credit = one hour of learning activity demonstrated by a reflective note on lessons learned and any changes made or planned (where applicable). The learning associated with activities that demonstrate impact can be still counted, proportionate to the time that they take, if demonstrated through a reflective note in this way.

Distance learning modules

Distance learning modules offered by universities for healthcare professionals involved in caring for those with a cancer diagnosis. 

Trainers’ workshop presentation

This workshop, presented at the Macmillan Primary Care Conference in November 2015, can be used to raise awareness of potential treatment consequences, provide hints and tips to reduce risk, identify and appropriately manage this group of people and also support signposting to relevant specialist services.

  • Trainers’ workshop presentation [link pending]

Background and evidence

It is estimated that at least 625,000 people living with and beyond cancer have one or more physical or psychosocial consequences of their cancer or its treatment that affects their lives on a long-term basis. In partnership with Macmillan and the Clinical Innovation and Research Centre, a toolkit for identifying and managing these consequences of cancer has been made available by RCGP for use by healthcare professionals. General practices can use this toolkit to manage these consequences of cancer, and support their patients to live well after a cancer diagnosis.

The following guidance and resources are designed to help commissioners implement the Consequences of Cancer toolkit in their area.

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