1 In all patients, be opportunistic in giving cancer prevention advice (e.g., stop smoking, reduce unprotected sexual intercourse, prevent human papillomavirus infection), even when it is not the primary reason for the encounter.
- This may include demographic features such as age or sex, or may be risk factors such as smoking, other exposures, or family history.
- Key historical questions: family history of malignancies (and age at diagnosis); radiation/sun/toxin exposure; smoking; alcohol.
2 In all patients, provide the indicated evidence-based screening (according to age group, risk factors, etc.) to detect cancer at an early stage (e.g., with Pap tests, mammography, colonoscopy, digital rectal examinations, prostate-specific antigen testing).
Please read “72. Periodic Screening” post that contains the up-to-date guidelines from the Canadian Task Force
3 In patients diagnosed with cancer, offer ongoing follow-up and support and remain involved in the treatment plan, in collaboration with the specialist cancer treatment system. (Don’t lose track of your patient during cancer care.)
4 In a patient diagnosed with cancer, actively inquire, with compassion and empathy, about the personal and social consequences of the illness (e.g., family issues, loss of job), and the patient’s ability to cope with these consequences.
5 In a patient treated for cancer, actively inquire about side effects or expected complications of treatment (e.g., diarrhea, feet paresthesias), as the patient may not volunteer this information.
Inquire and manage side effects or complications of cancer treatment:
- Constipation, Nx and Vx (Opioid induced, gastroparesis, Motion induced),
- Sedation (usually from meds),
- Delirium (infection,
- Urinary retention,
- dehydration, electrolyte imbalance, Drug interactions),
- dyspnea, Resp secretions,
- Anorexia, Mouth symptoms (thrush, ulceration, Crusting),
- Skin (pruritis, jaundice, wound pain, mal-odor, ascites
6 In patients with a distant history of cancer who present with new symptoms (e.g., shortness of breath, neurologic symptoms), include recurrence or metastatic disease in the differential diagnosis.
7 In a patient diagnosed with cancer, be realistic and honest when discussing prognosis. (Say when you don’t know.)
Note: For pain control, see the key features on chronic disease and palliative care. See also the key feature on depression.