Survivorship
Summary of Key Points
• The number of persons in the United States who are living with a cancer history will continue to rise during the next decade, reaching 18 million by the year 2022, and approximately two thirds of cancer survivors will be older than 65 years.
• Cancer survivorship, which is the period between the end of active cancer treatment and a recurrence or death from some other cause, is a distinct phase on the cancer control continuum with its own health care demands.
• The Institute of Medicine has identified four essential components of survivorship care considered to be critical for optimizing health after cancer: (1) detection of recurrent cancers, new cancers, and late effects of cancer and its treatment; (2) intervention for the long-term and late effects of cancer and its treatment; (3) prevention of recurrent and new cancers and other late effects; and (4) coordination between providers to ensure that all survivors’ health needs are met.
• Cancer and its treatment are associated with a variety of long-term adverse effects (e.g., pain, fatigue, sexual dysfunction, and bladder or bowel problems) or late-occurring adverse effects (e.g., recurrence/second malignancies, heart disease, diabetes, or osteoporosis) that can affect all aspects of a survivor’s life: physical, psychological/emotional, social, financial, and existential.
• Most cancer survivors are remarkably resilient and recover well after cancer, but some persons struggle with effects of their cancer and/or treatment.
Early assessment and intervention or referral for these effects has the potential to significantly reduce the burden of cancer.
• Cancer represents a “teachable moment” for many survivors, when clinicians have the opportunity to effectively promote healthy lifestyles and behaviors.
• Planning for posttreatment health and care, including use of treatment summaries and follow-up care plans and communicating these summaries and plans to survivors and their other care providers, is key to coordinated, comprehensive cancer care.
Ideally, planning for optimal survivorship starts at the time of diagnosis when decisions are being rendered that have the potential to affect the remainder of a survivor’s life.
• Screening family caregivers for psychosocial distress and referring them for supportive care as needed can improve survivors’ outcomes.
1. How many cancer survivors were alive in the United States on January 1, 2012?
2. What percentage of cancer survivors are currently older than 65 years?
3. Upon finishing curative therapy, survivors often report which of the following concerns?
4. Which of the following is TRUE about survivorship care plans (SCPs)?
A Because generating SCPs requires considerable time and resources, they generally are not recommended for clinical practice.
B SCPs are recommended for every survivor by the Institute of Medicine and will be required for accreditation by the Commission on Cancer to improve care coordination and survivor knowledge.
C The impact and utility of SCP use is supported by a wealth of scientific evidence, including randomized controlled trials.
D SCPs are already widely used by most oncology professionals.
5. Which of the following statements is FALSE/NOT TRUE regarding posttreatment survivorship care?
Posttreatment survivorship care …
A Offers an important “teachable moment” that can be leveraged by oncologists and other medical professionals to improve health behaviors of survivors and/or their caregivers.
B Occupies a unique place on the cancer control continuum, which necessitates a comprehensive approach to survivors’ long-term needs and coordination of multiple medical professionals.
C Should include only surveillance for recurrent cancers and be provided solely by oncologists.
D Presents unique challenges to the health care system because of the growing population of survivors and shortages of medical professionals.
1. Answer: D. The number of cancer survivors in the United States has grown steadily since the National Cancer Act was signed in 1971, increasing more than fourfold by 2012. Today, more than 65% of cancer survivors will live 5 or more years after diagnosis. The shift in these numbers has brought more attention to the need to understand and address the long-term and late effects of cancer and its treatment among those living with a history of this disease. Determining the best way to care for long-term cancer survivors represents a growing challenge to the clinical oncology community.
2. Answer: A. Cancer is generally a disease of aging. More than half of all cancers are diagnosed in persons aged 65 years and older. Notable exceptions are persons diagnosed with cervical cancer, breast cancer, or brain tumors; for these cancers, the percentage of those diagnosed at age 65 years and older is approximately 35% to 40%. With the aging of the U.S. population, the number of older cancer survivors is expected to increase dramatically in the next decade.
3. Answer: D. Cancer has the capacity to affect all aspects of a survivor’s life. Long-term follow-up studies demonstrate that survivors experience a number of adverse effects of cancer and its treatment that can persist for months and even years after treatment ends, including all of those listed. Inquiring about and addressing these adverse effects as appropriate is important in efforts to minimize the burden of cancer and promote full recovery.
4. Answer: B. Despite a lack of systematic evidence regarding their impact and utility, survivorship care plans that include information on the patient’s cancer and its treatment, along with an individually tailored follow-up plan for care and coordination, are recommended for use with all patients completing curative therapy for cancer. Development and delivery of SCPs will be required by the Commission on Cancer for accreditation purposes by 2015. Finding ways to make this process efficient and have it provide maximal information will be important for clinicians in the management of their busy practices.
5. Answer: C. It is now widely recognized that cancer survivorship brings a unique set of challenges. Because of the many lingering and late effects of cancer and its treatment, oncologists have an important role to play in communicating with survivors, their other health care providers, and key family members about how to manage these challenges once treatment ends. Engaging survivors in their own care and informing care providers who will be monitoring them about what to expect have the potential to reduce use of inappropriate surveillance tests, promote healthier lifestyles, improve care coordination, and lower rates of morbidity and mortality after cancer.
