Today I will talk on a model of cancer survivorship care for breast cancer patients in Korea. In Korea the elderly population is expanding rapidly and patient numbers are increasing rapidly. Fortunately, we give out cancer screening for breast cancer by using mammography; the uptake rates are about 70% recently and the cancer detection in all risk cases rate is rapidly increasing in Korea. So the five year survival rate for breast cancer is over 90% in Korea, so it’s fortunately good news but we are concerned about the cancer patients’ care, or called cancer survivorship, after treatment. Cancer patients and survivor numbers are rapidly expanding and the cancer patients are living longer after cancer treatment. But we developed cancer treatment skills in hospitals but we do not have good models for patient care in the community and after treatment.
I want to focus on a top model, recently we tried to care for breast cancer survivors in the community. Care means caring for their symptoms, physically and psychologically, but includes rehabilitation of their social functions and job return.
How do you address the psychosocial needs of cancer patients?
Our model is divided, measuring two. One programme is operating in hospitals – we opened cancer survivor clinics by physicians and we opened already multidisciplinary doctors’ rounds clinics, multidisciplinary doctors’ clinics, made of one patient but five doctors – one doctor is a breast cancer surgeon and one doctor, I am a family doctor, me, one doctor is a rehabilitation doctor, one doctor is a psychiatric doctor and one doctor is a pain management specialist or a gynaecology doctor. So we meet together for complicated problems in cancer survivors after treatment and we discuss many things and give our counsels about how the patient can deal with their cure after treatment. It includes symptom care and psychological support by drugs or counselling or how they can exercise, physical activities they are doing, and how they can eat healthily. About that we counsel and if there are any difficult problems, the patient suffers, for example, patients have oedemas and limitations of movement of their arms or the patients have severe depression and physical function is rolling. Then we refer to a specialist for evaluation and treatment.
This is one model in the hospital and in hospital we address the hospital model is we opened a comprehensive cancer survivorship care programme. The programme operates by the model of multidisciplinary teams, not only doctors but also we involve nurses, psychologists and the rehabilitation experts and social workers. When the patients are referred or come to the comprehensive cancer survivorship care programmes, we ask them to fill out a questionnaire to assess their problems. We define the risks they suffer based on the questionnaires. When we find the patients have a big problem and high risk for suffering ongoing and it has a big effect on their life quality, if they have a big need for medical care, then the coordinator of the programme reports to the doctors’ clinics. If they suffer from many economic burdens and family problems and social problems then they are referred to the social counselling teams. We communicate together, the medical teams and the social support teams, to help the patients to live well, better.
The other model we set usually in the community. We opened the Reborn Centres, the name means rebirth after treatment and beyond cancer. The Reborn Centres operate to support the rehabilitation of social functions and support job returns and start-ups for all cancer survivors. Recently three cancer survivors companies were working in the Reborn Centres and the Reborn Centre operates a regular education programme for job rehabilitation and start-up support. The Reborn Centre also functions as a network, a communication centre for other economic sectors and cancer survivors.
So we regularly make comprehensive seminars and we invite cancer patients and educate to roles as cancer patients’ mates. Mate means friend, not counsellors, they are not experts, but they have experience of overcoming cancer as patients and can be good friends, mates for the other cancer patients. The cancer patients’ mates can go with cancer patients to go shopping, to the park, for resting. Our education programme has modules like one day about the one hour activities of mothers and we educate and give roles to cancer patients’ mates and they can earn some money by these activities.
We educate the cancer survivors with some skills, to make some goods, then we open the market to sell the goods. It’s a kind of economic support. We also prepare small back gardens in cancer hospitals and invite some cancer patients and divide the garden into boxes. The cancer patients can grow flowers and vegetables in their boxes. After we provide the boxes, gardening boxes, cancer patients mostly really hate to come to the cancer hospital for treatment or diagnosis but they say, ‘I’m happy to come to hospital to see my flowers and vegetables growing.’ It’s another happiness and improves the life quality.
Recently we opened field gardens to grow vegetables. We shared small parcels of land for agriculture, a combination of rehabilitation physically and psychologically after cancer treatment. It’s our combination model, gardening and agriculture for cancer patients’ rehabilitation and cure.
We are starting and ongoing developing new models to support cancer survivors’ life quality, cure and rehabilitation in communities. We try to communicate with comprehensive care programmes in hospital and community activities. It’s an ongoing programme in Korea.
What overall message would you give to other countries?
The number of cancer survivors is encouraging and the cancer survival rate is increasing. But this means the cancer burden in societies and cancer survivors’ needs are increasing in society. We need to prepare to support cancer patients coming out from the patients to the healthy social members, to support the caring, comprehensive, that they have problems, to reduce their symptoms, physically, psychologically, and increase the physical functions. We need to support to rehabilitate their social functions and support their economic functions. They can make a return to healthy social members, we can do it. I think so.
