Cancer Survivorship is a Key Component in the Oncology Continuum of Care

With advancements in early detection and effective clinical treatment, more cancer patients are now becoming cancer survivors - an important implication for recognizing survivorship care as elemental to the continuum of oncology patient care.

According to the Centers for Disease Control & Prevention (CDC), cancer survivor "refers to an individual who has been diagnosed with cancer, from the time of diagnosis throughout his or her life. The impact of cancer on family members, friends, and caregivers of survivors is also acknowledged as part of survivorship."¹ As cancer has turned into "a curable disease for some and a chronic illness for others," the previously used term of "cancer victim" has now become obsolete, indicating a shift in how the survivorship of cancer is generally perceived.²

In the United States, from 1971 and 2001, the number of cancer survivors rose from 3.0 million to 9.8 million. Earlier this year in March, the CDC and National Cancer Institute (NCI) released an important epidemiological report which revealed that the most current data indicate that in 2007, the number of cancer survivors in the United States climbed to almost 12 million people, translating to approximately 3.9% of the population or approximately 1 out of every 20 individuals. Data from this report indicates that the majority of survivors are women (54%), and of these women, those who survived breast cancer compose the largest group (22%) of survivors out of all cancer types. Men who have survived prostate cancer make up the second largest group (19%) of survivors out of all cancer types. From the total of all cancer survivors, nearly 65% of all people with cancer have lived at least 5 years after diagnosis, while approximately 1.1 million have lived with a diagnosis of cancer for over 25 years.² As one author of the CDC/NCI report is cited explaining in an interview, "These numbers are really driven by the aging population, which is at a higher risk for cancer. The number of cancer survivors is expected to grow as the aging population grows. Life is not over when you get cancer. Many people are living a long time after diagnosis, and this is especially true for cancers that we have the ability to detect early."³

With the availability of this new data, the CDC is looking towards the implications these trends will have on public health practice. According to the CDC, "The increasing number of cancer survivors underscores the need for medical and public health professionals to address the potential long-term and late effects on survivors' physical and psychosocial well-being, provide survivors with coordinated care, and promote the importance of (1) healthy behaviors to reduce the risk for new or recurrent cancer, and (2) early detection to increase the likelihood of survival with new or recurrent cancer."²

Given the changing epidemiological landscape of cancer, public health professionals are now stressing the importance of addressing survivorship and quality of life issues as an integral component to the continuum of oncology patient care. In particular, follow-up cancer care is critical because it can assist with identifying any patterns of changes in health, including specific checks for recurrence, metastasis, the prevention or early detection of other types of cancer, other persistent medical issues as a result of cancer treatment, and any psychosocial effects.^4,5 For instance, during a follow-up care visit, some of the common questions that cancer survivors may pose include:⁶

• How often should I come in for a follow-up care visit?
• Do I need to see any other doctors from my care team as well?
• What test do I need?
• What can be done to relieve pain, fatigue, and other problems?
• How long will it take for me to recover and feel more like myself?
• Is there anything I can or should be doing to keep cancer from coming back?
• Will I have trouble with health insurance?
• Are there any support groups I can go to?

As part of incorporating survivorship into the larger continuum of oncology patient care, healthcare providers need to be prepared in responding to patient inquiries and providing on-target resources and tools.

Beyond coordinated follow-up care, other elements that are significant to survivorship care include patient-provider communication, health promotion, support groups and services, couples counseling, genetic counseling, fertility preservation and sexual counseling, home care services, pain management, physical therapy, nutrition counseling, financial counseling, and occupational/vocational counseling.⁵

To address the spectrum of cancer survivorship needs, the National Action Plan – a collaborative effort between the CDC and Lance Armstrong Foundation (LAF) – has developed the following sample of proposed recommendations and strategies:⁷

• Develop an infrastructure for a comprehensive database on cancer survivorship.
• Develop, test, maintain, and promote patient navigation systems that can facilitate optimum care for cancer survivors.
• Establish and/or disseminate clinical practice guidelines for each stage of cancer survivorship.
• Develop and disseminate public education programs that empower cancer survivors to make informed decisions.
• Conduct ongoing evaluation of all activities to determine their impacts and outcomes and ensure continuous quality improvement of services.
• Conduct research on preventive interventions to evaluate their impact on issues related to cancer survivorship.
• Educate policy and decision-makers about the role and value of long-term follow-up care, quality of life issues, legal needs, clinical trials, and ancillary services for cancer survivors.
• Empower survivors with advocacy skills.
• Educate decision-makers about economic and insurance barriers related to health care for cancer survivors.
• Establish and/or disseminate guidelines that support quality and timely service provision to cancer survivors.

Throughout the many touch points involved in the continuum of oncology patient care, a broad range of healthcare providers and professionals may interact with patients at some point throughout the course of care - establishing survivorship as part of this continuum is not only important, but given the epidemiological trends, will become increasingly more so.

For more information on cancer survivorship, please review the following resources:

http://www.cdc.gov/cancer/survivorship/basic_info

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm

http://www.cancer.gov/cancertopics/factsheet/Therapy/followup

http://www.cancer.gov/cancertopics/coping/life-after-treatment

http://www.cdc.gov/cancer/survivorship/what_cdc_is_doing/action_plan.htm

http://cancercontrol.cancer.gov/ocs/

http://csn.cancer.org/

http://journeyforward.org/

http://www.canceradvocacy.org/