As Dr. Muna Al-Khaifi graduated from family medicine and completed a fellowship in women’s health and breast diseases at the University of Toronto, she began to see a gap in breast cancer treatment — the time after a patient’s active treatment finishes.
“Rightfully a lot of attention is paid at the time of diagnosis and active treatment,” Dr. Al-Khaifi said. “Many breast cancer survivors have told me that while they felt they had a lot of information and support during their active treatment, once treatment stopped, they lost the continuity of care with the physician.”
It means patients are often left wondering what to expect, what to watch out for with respect to cancer recurrence, and what to do about ongoing side effects of treatment.
“After treatment ends, it’s very common for side effects to continue,” Dr. Al-Khaifi said. “It’s not just a ‘return to normal life.’ Pain. Lymphedema. Anxiety. Depression. Self-image changes. Sexual dysfunction. Menopausal symptoms that are caused by cancer treatment. And the fear of the cancer coming back. All of these contribute to the patient’s quality of life.”
Long-term survival rates after the diagnosis of breast cancer are improving, with a 5-year survival rate in Canada of 90 per cent.
“The continuing improvement in survival rate, coupled with an aging population, contribute to an increase in survival population. As a result, follow-up care with a focus on quality of care is increasingly important,” Dr. Al-Khaifi said. “Research shows that a quarter of breast cancer survivors report anxiety, depression and fears around recurrence, and anecdotally based on my experience with breast cancer patients, I believe the rate is much higher.”
Dr. Al-Khaifi wanted to improve the lives of breast cancer survivors and that’s why she developed and proposed the Sunnybrook Breast Cancer Survivorship Care Clinic. Currently she is the physician lead of the survivorship program at the Louise Temerty Breast Centre.
“I met a patient who had completed treatment and had a good prognosis. She was so acutely anxious of cancer recurrence and her self-image was so low after her body changes that she told me she didn’t leave the house. As a healthcare team, we have to support the whole person. We have to provide women like this with more support and resources after their active treatments like chemotherapy and radiation end.”
Dr. Al-Khaifi works with patients to create an action plan and address their side effects and concerns, and promote a healthy lifestyle to help reduce the risk of recurrence. She also works closely with family doctors to assist in the transition of care back to the community physician.
“Research shows family physician-led survivorship care is as good as specialist care with no difference in recurrence-related serious clinical events. Patients are generally more pleased with their care because it’s closer to home and more comprehensive, and their quality of life improves.“
The care is also individualized, she adds.
“Everyone is different, and everyone responds and reacts to cancer treatment differently. We use a practice-based, evidence-based and personalized approach to help support the whole person through their cancer journey.”
The approach can also have an impact on the healthcare system, she adds, by helping open up cancer physicians’ caseloads for active treatment patients.
“Plus, educating patients on what’s ahead and providing follow-up plans can help reduce fears, which reduces the demand for unplanned care and the amount of imaging, and the costs associated with that.
“So, this approach can be cost effective and beneficial for the healthcare system as well as patients. Further, this may support better coordination between cancer teams and family physicians through treatment summaries and survivorship care plans.”