Cancer survivorship Flashcards
Discuss trends in cancer mortality and survival
- 2021: > 10 mil, no. 6
- MIR in Au, NZ better than world average
- global risk factors different for different regions (low vs high SDI). Influenced by politics and policy, prevention strategies, generational effects
Risk factors in US/Au
- US: cigarette smoking> body weight> alcohol> UV radiation > physical inactivity
- 40% of incidence, 44% deaths = moddables
- 42% of burden attributed to these risk factors, tobacco 20% of burden
Cancer in au
- almost 50% diagnosed by 85
- aged standardised rates declining - females increasing due to “catch up habits”
- 5YS impriving; incidence increasing due to pop size and ageing
- rates beoming younger for certain cancers e.g CRC
- 5YS f> m
- ## trends in survival differ by cancer type: bladder decrease due to classing changes; Hodgkin and prostate improval, mesothelioma little change
Why 5YS
- Historically, surviving five years after diagnosis is a significant milestone and achievement. It became a benchmark for assessing treatment effectiveness.
- Patients who survived five years after diagnosis were often considered effectively cured or in long-term remission.
- A standard metric allowed consistent reporting across different studies and cancer types, making it easier to compare outcomes between different periods, treatments, and populations.
1 y vs 5 y gap
Population-Level Assessment
- A standardized measure for evaluating the overall effectiveness of cancer services in healthcare systems.
Important to Note:
- For some aggressive cancers, shorter-term survival rates may be more relevant (e.g., 1-year survival).
- For cancers with good long-term prognoses, 10-year or even longer survival rates are now reported.
- The concept of disease-free survival has been introduced to provide more nuanced information about cancer outcomes.
D
Discuss cacner surviorship in Au
- It is estimated that 3-5% of Australia’s population comprises people alive who were previously diagnosed with cancer:
- 10-year prevalence: 3%
- 35-year prevalence: 5%
- A greater proportion of people are being diagnosed with cancer - aging, population size/structure
Australia Cancer Survivorship Prevalence Over 10 Years (2006-2016)
What does the 10-year survival across age groups in Australia between 2006 and 2016 look like?
- Prostate Cancer: The most commonly diagnosed cancer in males.
- Breast Cancer: The most commonly diagnosed cancer in females.
Both cancers have high survival rates that significantly influence prevalence changes.
Compare chronic disease care vs survivorship care
Considerations:
- Socio-cultural norms and perceptions affect understanding, acceptance, stigmatization, and healthcare seeking.
- Impact of diagnosis on quality of life, work, and relationships.
- Special considerations for individuals with mental health issues, those living in remote areas, Indigenous status, migrants, or those disadvantaged with low health literacy.
Aspect | Chronic Diseases | Cancers |
| —————– | ——————————————————— | —————————————————————- |
| Patient | - Adherence to long-term medication regimen | - Adherence to treatment protocols |
| | - Lifestyle modifications | - Managing side effects during and after care |
| | - Regular monitoring and self-management | - Psychological support and coping strategies |
| Clinician | - Continuous monitoring and adjustment of treatment plans | - Multidisciplinary approach |
| | - Patient education | - Personalized treatment plans |
| | - Coordination with other healthcare providers | - Regular follow-ups and monitoring for recurrence |
| Health System | - Access to primary care and specialist services | - Access to specialized cancer treatment centers |
| | - Chronic disease management programs | - Availability of advanced diagnostic and treatment technologies |
| | - Support for lifestyle interventions | - Supportive care services (palliative care, rehabilitation) |
Consider needs of cancer patients and need for different care models
Cancer Care Issues for Patients:
-
Psychological and Emotional:
- During cancer care: Increased stress, anxiety, depression.
- After cancer care: Fear of recurrence, anxiety, financial toxicity, impact on family and relationships.
-
Physical:
- Bladder problems, bowel problems, fatigue, lymphoedema, mouth sores, nausea, vomiting, pain, sleep problems.
- Over 50% of early-stage survivors report at least five symptoms of moderate severity 12 months after diagnosis.
-
Practical Issues:
- Insufficient use of PROMs and PREMs.
- Challenges in accessing optimum care, sub-optimal management, and regional inequalities in resources and expertise.
Source: Managing physical changes due to cancer | Cancer Australia.
Treatment-Related Issues:
-
During Cancer Care:
- New treatments bring novel side effects with unknown long-term histories.
- Short-term issues exist but medium and long-term issues are also significant.
-
After Cancer Care:
- Medium-term: Lymphedema, menopausal symptoms, cognitive issues.
- Long-term: Increased risk of osteoporosis, chemotherapy and radiation-induced heart disease, treatment-induced secondary cancer.
Source: Cardiovascular disease following breast cancer treatment | European Heart Journal.
Define cancer survivorship and goals
- Definition: Cancer Survivorship encompasses the physical, psychosocial, and economic sequelae of cancer diagnosis and treatment among both pediatric and adult survivors. It includes issues related to healthcare delivery, access, and follow-up care for survivors.
Four Broad Goals of Follow-up Cancer Care
1. Prevention: Prevent recurrent and new cancers and the late effects of cancer treatments.
2. Surveillance: Monitor for cancer recurrence, other cancers, and possible late effects.
3. Interventions: Address consequences of cancer and its treatment (e.g., medical problems like lymphedema and sexual dysfunction, symptoms like pain and fatigue, and psychological distress).
4. Coordination: Ensure all survivor’s health needs are met, including health promotion, immunizations, and screening for both cancer and non-cancerous conditions, and care for concurrent conditions.
Discuss ScP
-
Content:
- Provide a cancer treatment summary.
- Set out a clear schedule for follow-up appointments and screening tests, with contact details for the health professionals involved in ongoing care.
- List any symptoms to watch out for and possible long-term side effects.
- Identify medical, emotional, psychological, or social needs after treatment and ways to manage them.
- Explain the roles and responsibilities of different healthcare team members and who to contact for concerns.
- Suggest ways to adopt a healthy lifestyle after treatment.
- Source: Cancer Council Australia - Survivorship Care Plans
Survivors/Thrivers and Survivorship Care Plans (ScP)
- Survivorship: The concept involves understanding and managing the complexities of life after cancer treatment.
- Clinician’s View: Emphasizes the importance of continuous care and monitoring after treatment.
- Health System View: Stresses the need for a coordinated approach across different levels of care.
Understanding Cancer Survivorship Care Plans Delivery in the Australian Health System
- Opportunities: Models of cancer survivorship care plans.
- Challenges: Difficulties in delivering Cancer Care Survival Plans.
Cancer Survivorship Care Plans in Australia
- Principles: Cancer Australia developed Principles of Cancer Survivorship, and the Clinical Oncology Society of Australia (COSA) recommended the Model of Cancer Survivorship Care.
- COSA Model: Focuses on survivor-centered, integrated, and coordinated care across all service levels at every time point.
- Fundamental Principles: Promote, prevent, manage, and ensure the availability of accessible and equitable care.
Models of ScP in Australia:
- Traditional Follow-up:
- Shared Care:
- GP-Led Care:
- Nurse-Led Care:
- Multidisciplinary Care:
. – costly
- Self-Management:
.
