The Lancet Oncology recently published a five-piece issue on cancer survivorship whose aim was to provide an update on the status of this evolving focus in cancer care. Below find a synopsis of some key points identified in each of the five articles:
Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA.1
In 2016, there are more than 15 million survivors in the US; this number is expected to rise to over 20 million within the next decade (2026);
On average, cancer survivors have five comorbid conditions;
Only a small percentage of long-term survivors who live free from their cancer experience no problems related to it. Hence, a new normal characterizes life after cancer;
The term “survivor” is not accepted by all diagnosed with cancer;
Many patients view the end of treatment with mixed feelings;
Survivors’ preferences for post-treatment care are varied, including who should provide the care and how the oncologist and primary care physician (PCP) should interface during this paradigm;
PCPs require interprofessional education about survivorship care.
Follow-up care of cancer survivors: challenges and solutions.2
Cancer survivors have considerable unmet needs that can be classified within the realms of psychosocial issues, economic problems, loss or change in employment status, struggle for meaning, spiritual distress, social isolation, and role disruption;
Varied models of survivorship care exist; a risk-stratified approach may work best in matching survivor need with intervention;
A projected workforce shortage of oncologists and PCPs will influence the design and implementation of survivorship care delivery models;
Significant barriers to the implementation of survivorship care plans prevail including a paucity of data on how these plans influence patient outcomes;
The creation of clinical pathways for use post-treatment completion may reduce gaps or barriers to care during follow-up.
Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities.3
Nearly half of all survivors are aged 70 years or older; the management of comorbidity in tandem with long-term effects supports some component of PCP involvement in survivorship care;
The three most common cancers in men (prostate, colorectal, melanoma) and women (breast, uterine, colorectal) account for more than 60% of all primary cancers of survivors;
The American Society of Clinical Oncology (ASCO) has outlined necessary core knowledge competencies for the education and training of PCPs providing survivorship care;
Risk stratification (low, intermediate, high) related to potential cancer-related sequelae post-treatment completion could be used to delineate the extent of PCP involvement in follow-up;
Financial and reimbursement barriers are considerable deterrents to survivorship care.
Provision of integrated psychosocial services for cancer survivors post-treatment.4
At least 40% of cancer survivors have diverse, often subclinical psychosocial issues such as fear of recurrence, post-traumatic stress symptoms, and depression and anxiety related to persistent symptoms, altered body image, existential questioning, social isolation, or employment, insurance and financial concerns;
The end of active treatment may be stressful rather than joyful as patients anticipate receiving less direct support and medical supervision from the treatment team;
There are 13 steps to consider for the integration of mental health services into survivorship care;
Intervention research should focus on survivors with clearly identified needs rather than all survivors regardless of clinical indication or need;
Care delivery models which integrate psychosocial care into survivorship care may be primary care/behavioral in nature, rehabilitation in focus, collaborative care in design, self-management in orientation, or home-based.
Evaluation of effectiveness of survivorship programmes: how to measure success?5
Appropriate measures to assess survivor program effectiveness include patient-reported outcomes, health-related quality of life, symptoms and health status, knowledge among survivors, and screening, surveillance and wellness, and health promotion activities;
Evaluation metrics are diverse and must be carefully chosen based on the nature and goals of survivor programs.
Nurses whose primary clinical focus is survivorship care should read this Lancet Oncology issue in its entirety. Others would benefit from reviewing individual publications in this issue relative to one’s interest. But we all in some way must enhance our awareness of this important focus within cancer care as it will only increase in importance and scope in the future.
Mayer DK, Nasso SF, Earp JA. Defining cancer survivors, their needs and perspectives on survivorship health care in the USA. Lancet Oncol. 2017 Jan;18(1):e11-e18.
Jacobs LA, Shulman LN. Follow-up care of cancer survivors: challenges and solutions. Lancet Oncol. 2017 Jan;18(1):e19-e29.
Nekhlyudov L, O’Malley DM, Hudson SV. Integrating primary care providers in the care of cancer survivors: Gaps in evidence and future opportunities. Lancet Oncol. 2017 Jan;18(1):e30-e38.
Recklitis CJ, Syrjala KL. Provision of integrated psychosocial services for cancer survivors post-treatment. Lancet Oncol. 2017 Jan;18(1):e39-e50.
Halpern MT, Argenbright KE. Evaluation of effectiveness of survivorship programmes: how to measure success? Lancet Oncol. 2017 Jan;18(1):e51-e59.
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