Cancer Survivorship

Question 1

What is the definition of cancer survivorship?

Answer 1

an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life

Question 2

Discuss the epidemiology of cancer survivorship.

Answer 2

• According to CDC, NCI, and ACS, the number of cancer survivors has increased from 3 million in 1971 to 13.7 million in 2012
• This is due to rising cancer incidence with aging population, earlier detection, better treatment
  
  • Site - The most common cancer sites in survivor population in order of prevalence are breast, prostate, colorectal, and melanoma
    
    • _​_these make up 60% of total survivors.
  • Time - 64% of survivors were diagnosed 5+ years ago, 15% were diagnosed 20+ years ago and 5% have survived 30+ years
  • Age - According to SEER data, 45% of survivors were 70 or older in 2012; 1 in 5 adults over the age of 65 is a cancer survivor
    
    • only 5% of cancer survivors are under 40 and survivors of childhood cancer make up 0.5-3% of the survivor population

Question 3

What are the major principles of cancer recurrence surveillance?

Answer 3

• Each type of malignancy has specific guidelines that include periodic history and physical, imaging, labs, and/or tumor markers
• Not all cancers require routine imaging and are followed clinically

Question 4

What are the most common physical effects of chemotherapy?

Answer 4

• 50% of survivors suffer from some late effect of cancer treatment
• Pain: Studies have indicated that up to 20% of diverse cancer survivors report cancer-related chronic pain and 43% report pain since their diagnosis
• Cardiac dysfunction
  
  • Vascular conditions include atherosclerosis, thrombosis, and hypertension
  • Cardiac structural problems: valvular degeneration can have a dramatic impact long term
  • Cardiac dysfunction and heart failure: potentially common late cardiac effects and can certainly be prevented or detected early during active cancer therapy to result in optimal outcomes.
• Cognitive deficits:
  
  • Chemotherapy induced cognitive changes have been reported in numerous studies
  • A national cross sectional study indicated that a history of cancer is independently associated with a 40% increase in self-reported memory issues
    
    • the mechanism is not clearly understood yet

Question 5

What are the psychosocial effects of cancer treatment?

Answer 5

• Experiencing some level of fear of recurrence is normative in cancer survivors
• Anxiety and depression affect up to 29% of survivors and the incidence of suicide among patients with cancer and survivors in the Unites States is about twice that of the general population
• Post-traumatic stress disorder affects as many as 32% of survivors.
• However, the prevalence estimates for psychosocial effects are wide-ranging
• Common risk factors for cancer-related distress:
  
  • physical symptoms treatment effects
  • younger age
  • nonwhite race / ethnicity group
  • less formal education
  • prior psychological disorders
• The “re-entry phase” of cancer survivorship

Question 6

What is the “re-entry phase” of cancer survivorship?

Answer 6

• The “re-entry phase” of cancer survivorship, when patients complete primary treatment, brings particular challenges
  
  • Survivors often feel they have lost the reassurance of active treatment and the safety net of frequent contact with providers
  • Survivors are often confused about who to see for follow-up care
  • There can be pressure to return to former roles at work and home
  • Survivors often experience a decline in interpersonal support
  • Many survivors are not adequately prepared for these challenges and report getting inadequate information about follow-up care

Question 7

What are the standards for survivorship care?

Answer 7

• The Institutes of Medicine and the National Cancer Institute have called attention to the need for more research to understand the needs of this population and optimal models of care
• The Commission on Cancer (CoC) of the American College of Surgeons developed new standards that will require CoC accredited hospitals to implement delivery of survivorship care plans for all patients completing cancer treatment as of January, 2015
• Survivorship Care plans include:
  
  • a personalized treatment summary
  • information on possible late and long-term effects
  • information on signs of recurrence
  • guidelines for follow up care
  • identification of providers
  • recommendations for healthy living
  • identification of supportive care resources
• The completion of primary cancer treatment can serve as an ideal time to promote positive health behaviors in survivors
  
  • However, research indicates that despite cancer survivors’ interest in health behavior change, they fare no better than the general population in executing those changes and do not regularly receive guidance on these matters from their oncologists