Historically, the term “cancer survivor” has had a variety of meanings. However, the more recently adopted definition refers to any person who has been diagnosed with cancer. As such, survivorship begins with the time of diagnosis and is inclusive of all subsequent time periods in that individual’s life – including the periods of initial treatment, cancer-free survivorship, chronic or intermittent cancer activity, and palliative care.
COMPONENTS OF SURVIVORSHIP CARE
Cancer patients, their caregivers and physicians must deal with a unique set of medical and psychosocial issues, which include the following critical components:
Surveillance for spread or recurrence of the initial cancer or second cancers
After treatment of a primary cancer, survivors are at increased risk of recurrence, which may occur at the primary site (local regional recurrence) or in a distant site (metastatic spread). Additionally, they are at increased risk of developing a secondary malignancy (i.e. a different type of cancer and also called “a new primary malignancy”) , either as a consequence of chemotherapy or radiation treatment or due to genetic, environmental, or lifestyle factors (e.g. smoking, obesity, etc.).
Attending to the psychosocial well-being of the cancer survivor
As a consequence of the disease and/or treatment, cancer survivors have an increased frequency of a number of psychosocial difficulties including anxiety, depression, fatigue, cognitive limitations, sleep disturbance, sexual dysfunction, and pain. These difficulties can be addressed and managed by patients and their physicians to try to minimize the adverse impact on quality of life.
Monitoring for long-term and late physical effects of cancer and its treatment
Cancer patients are at increased risk of long-term and late effects related to both their disease and its treatment, and these effects are of increasing importance as cancer survival rates improve. One such common effect in female cancer patients is premature menopause. Additional commonly reported effects include peripheral neuropathy and heart dysfunction. For some long-term or late effects, early identification and intervention may improve long-term function and reduce disability and possibly even reduce mortality. Thus, it is important that survivors are seeing health care providers who have an awareness of the potential for late effects of the treatments they received.
Attending to the fiscal well-being of the cancer survivor
Cancer survivors may face financial issues that cause psychological distress and interfere with receiving adequate medical care. If issues are identified, patients can be referred to hospital or community social workers, case managers, and patient assistance programs. They can be assisted by the social worker to complete the necessary paperwork to qualify for additional assistance to decrease the financial burden.
Coordination of care between specialists and primary care providers
Many cancer patients have additional medical conditions (co-morbidities) that were present prior to their cancer diagnosis or treatment or developed after treatment, and these conditions also need to be monitored and appropriately managed. The follow-up of cancer survivors can be shared by many physicians, including cancer specialists, primary care physicians, and other specialists. Coordination and collaboration between the cancer specialist, primary care provider, and other specialists involved in the patient’s care can ensure that all of the survivor’s health needs are met.
It is important that preventive measures and screening evaluations that may benefit a cancer survivor are appropriately included in their care and follow-up (e.g. flu vaccine, colorectal cancer screening in an individual who has undergone resection of an early-stage lung cancer). Additionally, lifestyle modifications, including healthy diet, physical activity, smoking cessation, and limitation of alcohol consumption, are important in improving quality of life, decreasing the risk of other diseases such as diabetes and heart disease, and potentially decreasing the risk of cancer recurrence.
For more information call 914-849-7500