BOX 5-2
Cancer as a Chronic Disease: Curriculum for Survivorship Required Objectives for Medical School Core Curriculum

Attitudes

  1. Comfortable prescribing medications for pain control, including opioids

  2. Comfortable asking new patients routinely about previous cancers

  3. Willing to ask oncologists for consultation when appropriate

  4. Considers general preventative issues as well as those related to cancer survivorship in cancer survivors

Knowledge

  1. 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

  2. Understands basic mechanisms of genetic contribution to risk of cancer

  3. Understands common uses of the terms “cure”, “disease free survival”, and “cancer survivor”

  4. Understands differences in cancer survivorship by gender, ethnicity and socio-economic status

  5. 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

  6. 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

  7. Understands consequences of cancer treatment for different developmental stages, including impact on growth, osteoporosis, learning, sexual function and fertility

Skills

  1. Able to use key screening guidelines to identify people at higher risk for cancer

  2. Able to provide appropriate and individualized recommendations for secondary prevention to cancer survivors regarding sunscreen, diet, obesity, exercise, alcohol, and tobacco

  3. Able to tailor pain medication and other interventions for pain to the source and type as well as the severity of pain

  4. 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

  5. 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”

  6. Able to partner with patients in decision making, respecting what is important to the patient

  7. Able to work as the primary care provider with a specialty team, providing continuity of care, and working with family as well as patient

  8. 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)

SOURCE: UCLA (2005b).



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