Cancer survivors require distinct care

November 07, 2005

WASHINGTON -- Citing shortfalls in the care currently provided to the country's 10 million cancer survivors, a new report recommends that each cancer patient receive a "survivorship care plan." The report, by the Institute of Medicine and National Research Council of the National Academies, says such plans should summarize information critical to the individual's long-term care, such as the cancer diagnosis, treatment, and potential consequences; the timing and content of follow-up visits; tips on maintaining a healthy lifestyle and preventing recurrent or new cancers; legal rights affecting employment and insurance; and the availability of psychological and support services. The committee that wrote the report also called for new evidence-based clinical guidelines and standards to assure the quality of care given to cancer survivors, as well as for better coordination between specialists and primary care providers.

"There is currently no organized system to link oncology care to primary care," said committee chair Sheldon Greenfield, professor of medicine and director of the Center for Health Policy Research, University of California, Irvine. "Successful cancer care doesn't end when patients walk out the door after completion of their initial treatments."

In the United States, half of all men and one-third of all women will develop cancer in their lifetimes. Advances in the detection and treatment of cancer, combined with an aging population, mean greater numbers of cancer survivors in the near future, the report notes. Despite the increase in survivors, however, primary care physicians and other health care providers often are not extremely familiar with the consequences of cancer, and seldom receive explicit guidance from oncologists, the committee found. Furthermore, the lack of clear evidence for what constitutes best practices in caring for patients with a history of cancer contributes to wide variation in care.

Besides being at risk for cancer recurrence and for developing other cancers, survivors also may face psychological distress, sexual dysfunction, infertility, impaired organ function, cosmetic changes, and limitations in mobility, communication, and cognition. Some of this is due to the fact that most cancer treatments -- including surgery, chemotherapy, hormone therapy, and radiation therapy -- can have long-term effects on tissues and organ systems.

"Unfortunately, many critical aspects of cancer survivors' needs are lost somewhere between active treatment and long-term follow-up, which is why we call for every patient to be given a summary of their cancer treatment and a description of follow-up care needed," said committee vice chair Ellen Stovall, a 34-year cancer survivor and president of the National Coalition for Cancer Survivorship. Such plans should be written by oncology providers and thoroughly discussed with patients, and the cost should be covered by insurers. The concept of a cancer survivorship plan was previously suggested by the President's Cancer Panel.

For survivorship plans to be carried out successfully, an organized set of clinical practice guidelines based on the best available evidence is needed, the report adds. Innovative models also should be developed to coordinate the care provided by oncologists, primary care doctors, nurses, social workers, psychologists, and others involved in addressing the myriad problems faced by cancer survivors. The committee said that the Centers for Medicare and Medicaid Services is in the best position to test the merits of various models of care through pilot programs funded by Congress. Both public and private support will be needed to develop new clinical guidelines and to monitor their impact.

Quality-of-care measures also are needed for cancer survivors, the report adds. Some measures -- such as annual mammograms for breast cancer survivors -- already exist, while others could be established based on available evidence, the committee said. For example, patients treated with certain chemotherapies should be monitored for heart conditions, and some individuals treated with radiotherapy need to be checked for thyroid conditions. Quality assurance programs to monitor and improve cancer survivors' care should be set up as well.

The committee recommended that medical education and professional training curricula include more instruction about cancer survivors' particular care needs. Expanded research - including long-term population studies -- also is needed to fill gaps in understanding of the effects experienced by cancer survivors later in life. Steps also should be taken to prevent discrimination against cancer survivors in the workplace and to ensure they have affordable health insurance and are reimbursed for evidence-based care. In addition, the committee called on health care providers and patient advocates to raise public awareness of the needs of cancer survivors and to establish cancer survivorship as a distinct phase of cancer care.
-end-
The study was sponsored by the National Cancer Institute, U.S. Centers for Disease Control and Prevention, and the American Cancer Society. The Institute of Medicine and the National Research Council are private, nonprofit institutions that provide science and health policy advice under a congressional charter. A committee roster follows.

Copies of From Cancer Patient to Cancer Survivor: Lost in Transition are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. The cost of the report is $69.95 (prepaid) plus shipping charges of $4.50 for the first copy and $.95 for each additional copy. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

[ This news release and report are available at http://national-academies.org ]

National Academies of Sciences, Engineering, and Medicine

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.