Survivorship and MDT working — structured oral station (12 minutes)

Opening prompt — "Tell me how you structure this survivorship visit."

Model response — say it in this order: ^[1]

• "I frame survivorship care as surveillance plus late-effect management plus psychosocial support, all documented in a survivorship care plan she and her GP hold. Today I will do four things: review for recurrence, screen for late effects, address her fear of recurrence, and update her plan."
• "I will explicitly ask about sexual function, lymphoedema, menopause symptoms and mood — the four late effects that are commonest and most often missed."
• "Her clear scans tell me this is a late-effect and psychosocial visit, not a recurrence visit — though I will keep new red-flag symptoms in mind."^[1]

Examiner is listening for: the integrated framing, the four-domain screen, and the judgement that this is a late-effects visit, not a hunt for disease. ^[1]

Probe 1 — "She describes painful intercourse that has ended her relationship. Manage this."

• "I would use permission-giving language first — 'Many women notice changes to their sexual health after this treatment' — because dysfunction is prevalent but under-reported unless invited."^[2]
• "The mechanism is radiotherapy-induced atrophy and fibrosis: the vagina shortens, narrows and loses lubrication. My ladder is non-hormonal first — a moisturiser for atrophy and a lubricant for activity — then topical vaginal oestrogen, which was studied in a randomised trial of dilator and topical agents for stenosis prevention after cervical radiotherapy."^[3]
• "Then vaginal dilator therapy, started now, used several times a week and long-term — and I know from the Law prospective study that adherence is the rate-limiting step, so I prescribe it with active support, not just a leaflet. I would add pelvic floor physiotherapy for hypertonicity and offer sex therapy."^[4]

Probe 2 — "She asks why she must keep coming for pelvic exams when her scans are normal. What is the evidence?"

• "I would be honest. In ovarian cancer, a retrospective series found most patients were asymptomatic when recurrence was detected, and the pelvic exam was not the primary means of detection — the authors argue the utility of routine visits and the pelvic exam should be re-examined."^[5]
• "In early endometrial cancer, a randomised trial showed patient-initiated follow-up was feasible and cost-reducing, with hospital visits easing fear of recurrence a little more."
• "So for her — cervical cancer — the vault review has a role because local recurrence is often visible and salvageable, but the value of the visit is the symptom review, the late-effect review and the fear-of-recurrence conversation, not the exam alone."^[5]

Probe 3 — "She is certain the cancer is returning. Address this."

This is a scored communication and rapport domain — demonstrate it out loud: ^[6]

• "I would name it: fear of cancer recurrence is near-universal and it is the single biggest driver of surveillance demand. No number of normal scans will fix the underlying fear."
• "I would screen her with the Distress Thermometer — paired with the Impact Thermometer — as a brief check for adjustment disorder or major depression, and treat a positive screen with structured psychological assessment."^[6]
• "Then I would give her a specific, written re-presentation plan: 'If you get new vaginal bleeding, constant pelvic pain, blood in your urine, or a swollen leg, call us — don't wait for your next appointment.' Converting dread into a sentence she can act on is the intervention."^[6]

Probe 4 — "She is frightened and tearful. Speak to her."

• Move to her eye level, use her name, acknowledge the fear plainly: "What you are feeling is very common after this treatment, and it does not mean the cancer is back. Your scans are clear. I want us to spend today on the parts of recovery that are hurting you — your relationship, your sleep, your worry — because those are treatable, and you deserve help with them."
• Avoid jargon, avoid dismissing, do not conduct the conversation with your back turned, and commit to follow-up.^[6]

Probe 5 — "How does the multidisciplinary team support her?"

• "Every new and recurrent gynaecological cancer patient is discussed at the MDT, which the European Cancer Organisation makes the structural backbone of care — producing a documented, individualised treatment and survivorship plan."^[7]
• "The team is gynaecological oncology surgeons, medical and radiation oncologists, radiologists, pathologists, specialist cancer nurses, allied health — lymphoedema and pelvic floor physiotherapy — psycho-oncology, and for the survivorship phase, primary care. For her specifically I would activate the lymphoedema service for her leg, the physiotherapist for her pelvic floor, and psycho-oncology for her fear of recurrence."^[7]