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.
