DISHA - The Journey Forward
Over the last four decades cancer treatment has evolved by leaps and bounds. Earlier it was assumed that most patients would die of the diseases, whereas today a majority of people with early diagnosis of cancer are expected to be cured.
World-wide it is estimated that there are approximately 30 million or more cancer survivors.
The largest group of cancer survivors in the USA are women who had breast cancer (23 %) followed by prostate cancer (in men 19 %), colorectal cancer (10 %) gynaecologic cancer (9 %), blood cancer (7 %) bladder cancer (6 %) melanoma (5 %) lung cancer (3%) and other (17%). We do not have any estimate for these figures in India.
During this period guidelines for Quality Cancer Care have become well defined and established. Quality Cancer Care not only includes different aspects of the Treatment Plan but also a detailed Survivorship Plan for each patient has become an integral part of Quality Cancer Care.
Who Is Cancer Survivor?
A Cancer Survivor is an individual who had cancer and is now living a life after the treatment of Cancer is over.
These may be individuals who after finishing their treatment have no signs of cancer, or they maybe those who are living with, through and beyond cancer. Surviving Cancer becomes a lifelong commitment and the patient need help with the problems they face, and for questions they have regarding their diseases , emotional, social, legal, financial needs etc.
Cancer survivorship maybe considered to be of three types
- Acute Survivorship which begins with the diagnosis of cancer and goes on to the end of treatment
- Extended Survivorship starts with the end of treatment and include the months and years after treatment is completed. Some of these individuals maybe on some maintenance treatment for cancer
- Permanent Survivorship starts after years have passed since the end of treatment and when recurrence is less likely
Clearly when the problems patients face in each phase of survivorship is different and hence plans have to be made to help them through each phase. It is only when we follow the guidelines of Quality Cancer Care that we can ensure that the cancer patient is comfortable and receiving optimal care no matter which phase of survivorship he or she is in.
What Is Quality Cancer Care?
All cancer patients are entitled to Quality Cancer Care which means we must ensure the patient has access to the following:
- Treatment that follows national and international guidelines and evidence based standards of care
- A Care that is comprehensive and takes care to treat not only the cancer but also the side effects of the cancer treatment
- A Care that is coordinated and ensures that there is good and effective communication between all the care providers involved and the patient
- There should be a written Treatment Plan with details of Cancer Care, which include clinical trials where newer treatment options and alternatives are required and available.
- An honest discussion regarding the intent of the treatment, after taking into consideration the patient’s preference and the prognosis of the diseases
- A detailed evaluation of the psychosocial needs of the patient and how these will be taken care of
- Palliative care from the diagnosis of cancer to the end of life
- End of life care
- Details of their health information
- A Health Information system which supports and improves all of the above
Once the treatment is finished the survivor should have access to
- A treatment summary and a customised survivorship plan
- Systems to monitors the health status of the patient and the risk of second cancer development and recurrence of the cancer
- Coordinated care for the complication that may have occurred due to the treatment and the cancer
- Treatment of the second cancer and or recurrence if it occurs
- A health insurance plan which pays for treatment of the second cancer/recurrence
What Is a Cancer Survivourship Plan?
Cancer Survivorship Plan (CSP) will provide you a roadmap to adjust to changes in relationships, careers, life style changes, anxiety of recurrence and general anxiety about your health. It will help you develop a wellness Plan to take care of your physical, emotional, social and spiritual needs. This plan will include and summarize:
- Long term side effects of cancer treatment
- Rehabilitation at home, work plan and in society
- Handling life after Cancer
- Follow up and screening for cancer (recurrence/new)
- How to deal with recurrence
- Recommendations for Healthy Living
- Tobacco Cessations Information
- Cancer prevention options
- Genetic Counselling
- Survivorship Resources, like emotional, financial, legal etc.
What Is Disha?
DISHA is the Dharamshila Initiative on Survivorship After Cancer, who we hope will take care of all aspects of cancer, which we hope will take care of all aspects of Cancer and Survivorship that we have explained in this brief write up.
With it we hope we can make your journey ahead and your life after cancer easier and more productive.
The Cancer Survivorship plan will help you address all issues of long-term health and wellness for you- “The Cancer Survivor”. It will give you a clear sense of “what next” after that your treatment is over.
Who Are Part of the Disha Team?
To help you in your journey forward the DISHA Team will includes
- An oncologist
- A senior nurse who has worked with cancer patients
- A psychologist
- A Social workers
- A Secretary to help you, coordinate all these
