Colorectal cancer is the third most common type of cancer in the US, but it is also one of the most preventable cancers if people get screened on time and correctly. To get the best cancer care, you need to work closely with a doctor you trust for the whole process, from prevention and screening to treatment coordination and long-term survivorship. The Direct Primary Care (DPC) model is meant to encourage and support this kind of partnership.
Colorectal cancer is a type of cancer that begins in the colon or rectum. It usually starts out as a small, precancerous growth known as a polyp. Some kinds of polyps can turn into cancer over time.
The Strength of Screening: Screening is the best way to fight this disease. There are two ways it can save lives:
Screening tests can find and remove precancerous polyps before they have a chance to turn into cancer.
Early Detection: Screening can find cancer early, when it is easiest to treat. More than 90% of people with localized CRC live for at least five years.
Current Guidelines for Screening: The U.S. Preventive Services Task Force now says that people at average risk should start getting screened for colorectal cancer at age 45. This is because the disease is becoming more common in younger adults. There are different ways to screen for colon cancer, such as stool tests (like the FIT test every year or the Cologuard test every three years) and direct visualization tests (like a colonoscopy every ten years).
Direct Primary Care (DPC) is a membership-based model that lets patients talk to their doctor whenever they want. DPC is very important for the whole continuum of care for a serious health problem like colorectal cancer.
Being very good at preventing and finding things early: This is the most important thing your DPC doctor does.
More screenings that save lives: Research shows that people who have a good relationship with their primary care provider are more likely to get screened. DPC's proactive, relationship-based model is meant to make sure you get the screening that was suggested for you.
Real Shared Decision-Making: Your DPC doctor has time to talk to you in depth about the pros and cons of each screening option (like Colonoscopy, Cologuard, and the FIT test) so you can choose the one that you feel most comfortable with. The test that gets done is the "best."
Seamless Coordination: They can help you get a colonoscopy referral and prepare your bowels, or they can give you a kit in the office for a stool-based test to make the process as easy as possible.
A "Home Base" While Getting Cancer Treatment: If you find out you have cancer, the journey gets complicated and scary. Your DPC doctor becomes your rock and your voice.
Putting together your care team: They are like your "quarterback," making sure that your oncologist, surgeon, and radiation oncologist can talk to each other without any problems.
Taking care of you, the patient: Your DPC doctor focuses on you while the specialists focus on the cancer. They help you deal with the side effects of treatment, coordinate care for your other health problems, and give you and your family important psychosocial support.
Full, lifelong care for survivors: A new journey starts after cancer treatment is over. DPC is the best place for care after cancer.
Putting Your Survivorship Care Plan into Action: Your DPC doctor can help you with your long-term health plan, just like the American Cancer Society says they should.
Putting together surveillance: They make sure you get your follow-up colonoscopies, lab work, and scans on time so that they can check for any signs of cancer coming back.
Taking care of late effects: They help you deal with the long-term physical and emotional effects that can happen after cancer treatment.
Promoting overall health to help you stay as healthy as possible for the rest of your life.
Case 1 (Screening): David, 46, has been putting off his first colonoscopy. His DPC doctor talks about all the screening options for 30 minutes. They agree that an at-home stool test (FIT) is a good first step for him. The DPC practice makes it easy for him to take the test. The test comes back positive, and the DPC doctor then easily sets up the follow-up diagnostic colonoscopy. The colonoscopy finds a big polyp that could turn into cancer. David has it removed, which means he will never get cancer.
Case 2 (Survivorship): Linda is 68 years old and has been cancer-free for three years. Her DPC doctor is now in charge of her full survivorship plan. The doctor makes sure that her surveillance bloodwork and scans are done on time, helps her deal with the neuropathy in her feet that she got from chemotherapy, and gives her advice on diet and exercise to lower her risk of getting cancer again.
Q: I'm 45 years old and in good health. Is it really time for me to start screening for colon cancer? A: Yes. Because the number of adults under 50 getting colorectal cancer is going up at an alarming rate, major national guidelines now strongly recommend that all average-risk people start screening at age 45.
Is a Cologuard stool test done at home as good as a colonoscopy? A: They are different, but both are great tests for screening. Tests that look at stool are not invasive and are very good at finding cancer, but they need to be done more often. If a colonoscopy is normal, you only need to have one every ten years. It is better at finding and removing precancerous polyps (prevention). Your DPC doctor can help you choose the best way to screen for cancer.
Q: I'm done with my cancer treatment. What is a survivorship care plan, and why do I need one from my DPC doctor? A: Your oncologist knows the most about your cancer. Your DPC doctor knows you best. The American Cancer Society says that your survivorship plan, which is managed by your DPC doctor, makes sure that you get coordinated monitoring for recurrence, proactive management of any long-term treatment side effects, and full care for all of your other health needs to keep you as healthy as possible for the rest of your life.
DPC has a clear advantage for this common and preventable cancer because
More screenings that save lives: The DPC model's proactive, relationship-based approach has been shown to help people follow through with recommended screenings.
Giving Patients Real Shared Decision-Making: DPC gives patients the time and trust they need to choose the screening method that works best for them and their values.
Providing Comprehensive, Coordinated Survivorship Care: DPC is the best medical home for cancer survivors to get long-term health care, monitoring, and support.
Colorectal cancer is a very serious disease, but it is also very treatable and, most importantly, mostly preventable. You need a health partner who is dedicated to either preventing disease through screening or helping you through the process of surviving after a diagnosis. Direct Primary Care is the proactive, personalized, and ongoing partnership you need to stay healthy at every stage.
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