Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain.

PurposeThe needs and concerns of patients with advanced breast cancer are changing at every phase of the care intervention. Management and coordination of hospital resources and services are also steadily evolving. The objective of the present expert report is to define a new oncology nursing role specialising in advanced breast cancer, to help guide patients throughout the whole healthcare itinerary.MethodsA group of eight experts in oncology nursing and medical oncology defined the content index of the curriculum document. A systematic review of bibliography was carried out, and the relevant contents were extracted. Based on these contents and the participants’ experience, recommendations were formulated and validated through a Delphi questionnaire and a participative meeting.ResultsThe advanced breast cancer clinical nurse (ABCCN) should develop a clinical, psychosocial role focused on coordinating patients in the healthcare network. The nurse would be in charge of evaluating and supervising the care administered and the healthcare resources used. The ABCCN should be aware and participate in the protocols and available resources, be able to solve conflicts, deal with burn-out signs and have clinical, coaching and team-working abilities. The proposed curriculum provides a specific process for the care of patients, as well as an implementation process.ConclusionsThe ABCCN’s role is crucial to assume the best care and the optimisation of available resources. This review and consensus document provides the required tools for the implementation in hospitals.

Introduction and epidemiologyBreast cancer is the most frequent neoplasia among women and represents 30% of all cancers. In Catalonia in 2002, the crude incidence rate was 116.5/100,000 women and the age-adjusted incidence rate in the world standard population was 70.9/100,000 women. Breast cancer is the main cause of cancer death in women. Mortality increased until 1991Mortality increased until -1992, and then decreased up to the present. The adjusted mortality rate rose from 17.8 cases/100,000 women in 1985 to 18.8 in 1995. It then dropped to 15.3 cases/100,000 women in 2002. There are several reasons for this change, including therapeutic advances and the introduction of measures for the early diagnosis of breast cancer. Five-year survival from breast cancer increased significantly to 75.9% in 1990-1994, then to 80.9% in 1995-1999 [3-5].The main risk factors for breast cancer are related to hormonal, reproductive, sex, age and family history factors. Between 15 and 20% of new cancer cases are estimated to occur in a family with a history of cancer and from 5 to 10% of cases could be related to the inheritance of a genetic predisposition to the disease. The discovery of cancer-related genes has enabled carriers of an inherited predisposition to cancer to be identifi ed, so that the risk can be defi ned and prevention behaviour encouraged. In addition, specifi c screening can be undertaken in order to make early diagnoses [6][7][8]. Guidelines for suspected cancerThe main aim is to obtain a pathological diagnosis of the lesion before therapy begins. Studies of patients with suspected cancer should include the following tests: clinical examination, imaging and biopsy. [S]Evidence shows that the combination of these three investigations (the triple test) leads to higher diagnostic accuracy [9] [II], [SIGN] [10].

One of the consequences of diagnostic and therapeutic progress in cancer is the increased survival observed in the last few decades in Spain and elsewhere in Europe. New cancer cases are increasing steadily due to population aging, among other factors. Consequently, the number of long-term survivors can be expected to increase in the years to come. This increase will tax healthcare systems, which are already showing the limitations of the present model of follow-up. New scenarios should be assessed and proposed from both the management and clinical perspectives. Although there is insufficient scientific evidence to indicate the most effective way to organize the follow-up of these patients, several approaches are being proposed in other countries to improve the fit between health services provision and the specific needs of these patients. In Spain, these experiences are scarce. However, given the situation, which could be described as a snowball effect, the current model should be reviewed and new approaches discussed in order to provide a more effective response to this situation. This article aims to identify the priorities for cancer survivors from the healthcare point of view, to review organizational approaches in other countries, and to propose a framework, based on the integration of the different levels of health care, including primary care - the Cinderella of this situation - in order to assess various healthcare options for these patients in the Spanish healthcare context.