. "5 Providers of Survivorship Care: Their Supply and Education and Training." From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press, 2005.
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From Cancer Patient to Cancer Survivor: Lost in Transition
BOX 5-2 Cancer as a Chronic Disease: Curriculum for Survivorship Required Objectives for Medical School Core Curriculum
Attitudes
Comfortable prescribing medications for pain control, including opioids
Comfortable asking new patients routinely about previous cancers
Willing to ask oncologists for consultation when appropriate
Considers general preventative issues as well as those related to cancer survivorship in cancer survivors
Knowledge
Understands that all cancer survivors are at increased risk for other cancers as well as recurrence of the original cancer, and need to avoid tobacco, eat right, and use sunscreen
Understands basic mechanisms of genetic contribution to risk of cancer
Understands common uses of the terms “cure”, “disease free survival”, and “cancer survivor”
Understands differences in cancer survivorship by gender, ethnicity and socio-economic status
Understands the variety of social consequences of cancer on survivors, including difficulty getting employment and insurance, stigma, and the impact on the family and friendships
Knows the essential elements to obtain about a cancer history, how to get information the patient can’t give them, and how to interpret the health implications of the history
Understands consequences of cancer treatment for different developmental stages, including impact on growth, osteoporosis, learning, sexual function and fertility
Skills
Able to use key screening guidelines to identify people at higher risk for cancer
Able to provide appropriate and individualized recommendations for secondary prevention to cancer survivors regarding sunscreen, diet, obesity, exercise, alcohol, and tobacco
Able to tailor pain medication and other interventions for pain to the source and type as well as the severity of pain
Able to explain and help patients make decisions about a living will, do not resuscitate (DNR) orders, durable power of attorney, and advance health care directives
Able to give bad news about second malignancy or relapse, and to move to a palliative approach when appropriate without saying “there is nothing we can do”
Able to partner with patients in decision making, respecting what is important to the patient
Able to work as the primary care provider with a specialty team, providing continuity of care, and working with family as well as patient
Able to get current cancer information for cancer survivors at the appropriate reading level and language (e.g., from the Cancer Information Service and National Cancer Institute)
