People with cancer often view survival as the ‘finish line.’ This is a common misconception, and many survivors are surprised to find themselves in an additional and unexpected leg of the race—survivorship and all the additional challenges that encompasses.
Survivors face unique challenges, and this makes it all the more important for healthcare providers to have a good understanding of these challenges, particularly if they will be treating survivors—and chances are good that at some point, they will be. As of January 2019, 16.9 million Americans are cancer survivors, with 64 percent over the age of 65. By 2029, researchers project that number to increase to 21.7 million.1
Cancer survivorship is a phenomenon, a movement, and a phase of the cancer control trajectory. This phenomenon originated with an article penned by Fitzhugh Mullan, MD, who recounted his experience as a physician with cancer.2 The following year, he and other cancer leaders formed the first survivor-led organization to advocate for quality care for cancer survivors.3
Since that time, survivorship has evolved into a movement that has increased awareness about the growing population of survivors, the morbidities associated with cancer treatments, and the gaps in care following the treatment phase.
Understanding the Needs of Cancer Survivors
Several reports have been published by the Institute of Medicine 4, 5, 6, 7 that describe:
- The physical and psychosocial needs of cancer survivors throughout the lifespan
- Gaps in care
- Recommendations to address these concerns
The seminal report that led the way to improving care for adult cancer survivors was “From Cancer Patient to Cancer Survivor: Lost in Transition.”5 Of the twelve recommendations proposed in this report, the second recommendation has become a primary mantra for the cancer centers and organizations responsible for establishing standards for quality cancer care.
A Mantra for Cancer Survivors
The mantra established in the Institute of Health report is:
Provide a treatment summary and survivorship care plan to cancer survivors at the completion of cancer treatment.
What are the two aspects of this mantra?
- The treatment summary covers the completed cancer treatment.
- The survivorship care plan addresses the survivor’s future care.
The 2006 Institute of Medicine report recommended that the survivorship care plan be comprised of four essential components:
- Prevention of new cancers, possible recurrence, and late effects
- Surveillance of possible metastasis or recurrence, second cancers, and medical and psychosocial late effects
- Treatment of effects associated with cancer and its treatments, such as medical and psychosocial problems, and issues related to employment, insurance, and disability
- Coordination of care between the survivor’s specialists (for example, oncologists) and the primary care provider
As the number of cancer survivors continues to increase, it is imperative for healthcare professionals to know what survivorship means, why it is so important, and what resources are available to learn more about it. A good place to start is the MedBridge course, “Cancer Survivorship: Historical Foundations and Current Trends.”
- National Cancer Institute. (2019). Division of Cancer Control & Population Sciences: Definitions, Statistics, & Graphs. Retrieved from https://cancercontrol.cancer.gov/ocs/statistics/statistics.html
- Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. New England Journal of Medicine, 313: 270-273.
- Stovall, E. (2008). National coalition for cancer survivorship: Advocating for quality cancer care for all. Journal of Oncology Practice, 4: 143.
- Institute of Medicine and National Research Council. (2003). Childhood cancer survivorship: Improving care and quality of life. Washington, DC: The National Academies Press. Retrieved from: https://www.nap.edu/catalog/10767/childhood-cancer-survivorship-improving-care-and-quality-of-life
- Institute of Medicine and National Research Council. (2006). From cancer patient to cancer survivors: Lost in transition. Washington, DC: National Academies Press. Retrieved from https://www.nap.edu/catalog/11468/from-cancer-patient-to-cancer-survivor-lost-in-transition
- Institute of Medicine. (2008). Cancer care for the whole patient. Washington, DC: National Academies Press. Retrieved from: https://www.nap.edu/catalog/11993/cancer-care-for-the-whole-patient-meeting-psychosocial-health-needs
- Institute of Medicine. (2013). Delivering high quality cancer care. Washington, DC:National Academies Press. Retrieved from: https://www.nap.edu/catalog/18359/delivering-high-quality-cancer-care-charting-a-new-course-for