More and more people live long and productive lives after cancer diagnosis and treatment, thanks to the continued advancements being made in cancer research. Only recently have researchers been able to study long-term survivorship and start to understand the implications that cancer treatment has on survivors’ lives after cancer. Doctors and researchers are learning that providing quality health care for cancer survivors means planning, communication and attention to a broad scope of health factors.
After treatment, cancer survivors often face a health care crossroads, unsure when to consult their oncologist versus their primary care physician for health concerns. While one’s oncologist may not be appropriate for every health issue, establishing good primary care that encompasses past treatment and future risk can be challenging.
Featured below are the audio files and transcripts regarding some approaches to survivor health care for survivors of all types of cancer, as well as their caregivers and families.
The definition of “survivorship” can vary and sometimes cause confusion. Some define survivors as “five years post-diagnosis.” The Institute of Medicine (IOM) defines cancer survivor as one who has completed treatment for their initial cancer — this is usually six months post-diagnosis. The National Cancer Institute and the National Coalition for Cancer Survivorship have adopted the definition of cancer survivorship as being from the time of diagnosis, through the balance of life. VCU Massey Cancer Center's Adult Cancer Survivorship Clinic uses the IOM definition.
By any definition, cancer survivorship has increased drastically. In 1971 there were 3 million survivors, a number which grew to 10 million at the end of 2001. It is estimated that there are approximately 10.5 million survivors in the U.S. today. Of those, 60 percent are over the age of 65 and 14 percent were diagnosed more than 20 years ago. The most prevalent types of cancer among survivors are breast cancer, prostate cancer and colorectal cancer. It is expected that in the next eight years, the number of survivors in the U.S. will almost double. There are a number of reasons why cancer patients are living so much longer:
- Greater public health push toward screening has lead to earlier detection
- New drugs and technology for treatment
- Effective combination therapies and prolonged maintenance therapies
Now that patients are living longer from their treatments, the challenges of survivorship are becoming more evident. A poll done by the Lance Armstrong Foundation of 1,020 patients showed the following:
- 54 percent experienced chronic pain
- 70 percent experienced depression
- 58 percent reported loss of sexual desire and/or sexual function
- 43 percent reported decrease in income
- 32 percent reported a lack of advancement, demotion or job loss
- 86 percent stated that they did not move to a new location as a result of cancer
- 71 percent did not travel someplace special due to cancer diagnosis
Some challenges faced by survivors are due to the treatments that they receive. Late medical effects can depend on the kind of treatment — surgery, radiation, chemotherapy — that is received. Examples of common late medical effects include lymphadema, premature menopause, infertility, bone fractures and chronic pain.
It is only recently that cancer research and treatment has expanded to include survivorship care. The focus has been more on prevention, early detection, diagnosis, management and supportive care. As more people live longer lives after cancer, the standards of care are gradually expanding to include important tools such as, survivorship clinics, treatment summaries and long-term care plans to help survivors and their health care providers ensure quality long-term health management.
“Survivorship Care Planning” is a presentation by Craig C. Earle, M.D., medical director, Adult Survivorship Program, Dana-Farber Cancer Institute, Harvard Medical School
“Survivorship Care Models” is a presentation by Mary McCabe, R.N., M.A., director, Cancer Survivorship Program, Memorial Sloan-Kettering Cancer Center
Massey now offers an innovative, multidisciplinary Adult Survivorship Clinic to help manage the unique health care needs of the cancer survivor. The goals are to:
- Help improve the quality of life of survivors of adult cancer
- Help survivors with the physical, psychological, social, spiritual and financial issues faced throughout the remaining years of their lives