Consequences of Cancer and Treatment

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

• Top tips for 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.

• Tips for carrying out an effective Cancer Care Review 

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

• Where to find the cancer care review template on EMIS 
• Summary of the cancer care review template evaluation 

For more information on diagnosing and treating cancer in primary care, the RCGP has a Primary Care Cancer toolkit.

Quality Improvement

To access shared learning networks to assist you in applying practical QI methodologies to better treat this clinical area, join our QI Ready platform.

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 

Recovery Package Good Practice Guide

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.

• Common helpful READ codes for managing patients at risk 

Potential consequences of treatment

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

• Summary of potential consequences 
• Summary of long term consequences by treatment type

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.

• Managing erectile dysfunction after surgery for pelvic cancers 
• Managing erectile dysfunction after radical radiotherapy and androgen deprivation therapy (ADT) for prostate cancer 
• Managing lower gastrointestinal problems after cancer treatment - quick reference guide
• Managing lower gastrointestinal problems after cancer treatment - one page summary
• Managing heart health after cancer treatment - quick reference guide
• Managing heart health after cancer treatment - one page summary 
• Guidance on long term consequences of treatment for gynaecological cancer 
• Managing fatigue - primary care ten top tips 

Other useful guidance

• Guidance on Prostate Cancer (NICE 2014)
• Guidance on Colorectal Cancer (NICE 2011)
• International guidelines on vaginal dilation after pelvic radiotherapy (2012)
• Reducing the Risk of Upper Limb Lymphoedema (RCN 2011)

Booklets for patients

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

• What to do after cancer treatment ends [PDF]
• Life after cancer treatment [PDF] - Order booklets
• Worrying about cancer coming back [PDF] - Order booklets
• Coping with fatigue [PDF] - Order booklets  
• Body image and cancer [PDF] - Order booklet 
• Weight management after cancer treatment [PDF] - Order booklet
• Bone health [PDF] - Order booklets 
• Sexuality and cancer for men [PDF] - Order booklets 
• Sexuality and cancer for women [PDF] - Order booklets
• Cancer treatment and fertility – Information for women [PDF] - Order booklets
• Cancer treatment and fertility – Information for men [PDF] - Order booklet
• Managing the late effects of breast cancer treatment [PDF] - Order booklets
• Managing the late effects of bowel cancer treatment [PDF] -  Order booklets
• Managing the late effects of head and neck cancer [PDF] - Order booklets
• Managing the late effects of pelvic radiotherapy in men [PDF] -  Order booklets
• Managing the late effects of pelvic radiotherapy in women [PDF] -  Order booklets
• Understanding lymphoedema [PDF] - Order booklets 
• Top tips for the self management of lymphoedema - A Guide, The Lymphoedema Project for Scotland (2012) 
• Holistic Needs Assessment patient leaflet

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.

• Toilet card [order form]
• Order a Radar Key 

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.

• The importance of physical activity: a concise evidence review 
• Interventions to promote physical activity: a review 
• Delivering physical activity advice – Online training sessions 2016
• Further information on physical activity and cancer 

Patient information

• Get Active DVD [order form]
• Move More - your complete guide for becoming more active [Order pack]
• Walking for Health - find a walking scheme near you

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.

• Work support route guide
• Financial guidance tool
• Information on working during and after a cancer diagnosis
• Help with the cost of cancer

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.

• Access the e-module (BMJ Learning) 

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.

• Revalidation toolkit (Macmillan)*
• The GMC’s supporting information for all appraisal and revalidation 

*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. 

• Supporting patients living with and beyond cancer (Edinburgh Napier University)

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]

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.

• Throwing light on the consequences of cancer and its treatment - This report provides a summary of the best available evidence on the consequences of cancer.
• Achieving World Class Cancer Outcomes: A Strategy for England 2015-2020 - Report of the Independent Cancer Task Force (July 2015) 
• Evidence, policy and patient experience 

The RCGP also has an Early Diagnosis of Cancer Significant Event Analysis toolkit to enable CCGs find emerging themes and use local intelligence to address and manage issues; a Primary Care Cancer toolkit to assist with prevention, diagnosis and referral, and a Brain Tumours in Children toolkit, which provides specific referral and red-flag information.

This toolkit was developed as part of the wider Consequences of Cancer Spotlight Project, which was a one year collaboration between Macmillan Cancer Support and the RCGP from 2015-16. This report reviews the project’s impact and legacy.