Beginning (Again) After the Battle: A Look at Survivorship
Author: Becky Gold
June is Survivorship Month! We will take a look at what survivorship is, and what some current methods for it are. Normally, Research Corner focuses on new research for cancer treatment, but survivorship is a bit different. Survivorship is relatively new idea, historically speaking. The fact that we have more cancer survivors than ever before is only part of it—the other part stems from a new push in medicine to treat the whole person rather than just the disease.
Survivorship focuses on the post-cancer treatment life and health of a patient, both in the short and long term. It encompasses physical, emotional, psychosocial, and economic aspects of cancer beyond the diagnosis and treatment stages, including (but not limited to) after effects of treatment, secondary cancers, follow-up treatment, quality of life, issues accessing care, and social and emotional effects of cancer. Family members, friends, and caregivers are also considered to be part of the survivorship experience. Read more about survivorship here, and check out the links below for resources!
The paper this post will focus on looks at current survivorship methodologies and processes to develop survivorship plans that best support the post-treatment issues cancer patients face in the short and long term. The authors identified 5 key domains for survivorship related to cancer and its treatment as well as general healthcare, and discuss how to best achieve the goals related to each domain.
Prevention and surveillance for recurrences and new cancer: Risk assessment is key here! Factors such as primary disease, lifestyle behaviors, treatment exposures, and genetic predisposition should all be taken into account when making a plan for prevention and surveillance. Lifestyle modifications may be part of this plan, in addition to the frequency and type of screening for cancer that is recommended.
Surveillance and management of physical effects: This domain aims at addressing and treating continuing physical effects of treatment, or any new ones that may occur in the future due to the previous treatment.
Surveillance and management of psychosocial effects: After treatment, cancer survivors may have a myriad of psychosocial effects. These may include psychological effects (including new depression and/or anxiety), fear of recurrence, financial hardship, decrease in productivity, loss of or changes in insurance, challenges returning to work or school, and interpersonal relationship challenges. These issues can and should be addressed through social services (when applicable) and evidence-based guidelines for such issues.
Surveillance and management of chronic health condition: Treatment for pre-exisitng and new conditions should be done within the context of the patient’s cancer status.
Health promotion and disease prevention: Cancer survivors should still follow recommended screening and health guidelines that apply to the non-cancer population, including steps to a healthy and balanced lifestyle. However, these again should be considered within the context of the patient’s cancer status—some traditional recommendations may not be possible for some survivors due to treatment effects.
The authors also discuss a myriad of challenges when it comes to survivorship. Arguably, the biggest of these challenges is that there is not one prescribed survivorship path, and various care teams place varying emphasis on its importance. While survivorship plans should be individualized to the patient, some sort of framework should exist to help guide providers in building this plan, relying on both evidence and patient preference to help determine which aspects are the most important to emphasize in their survivorship plan.
The paper also noted accessibility as a major challenge to survivorship. Not all cancer survivors are in a geographic area that allows them to access the broad and integrated care needed for survivorship easily, and this in and of itself may prevent them from engaging with a survivorship program. Telemedicine and transportation services offer a solution to part of this problem, although these solutions do not address the burden of time lost from work or other activities due to distance. From a financial point of view, both patients and providers face challenges. Survivorship care may be expensive to the patient and may not be covered by insurance. Providers face a similar challenge—survivorship care may not be adequately reimbursed by insurance companies.
So, what’s next? How can we improve survivorship outcomes, keeping the idea of the “whole patient” in mind? Remembering that the cancer experience doesn’t end the day treatment does is the first key. Support of patients and families shouldn’t end when treatment does. Second, research supporting the fact that survivorship programs increase quality and longevity of life should continue to be published and dispersed, hopefully leading to policy changes that help ease the financial barriers to access for patients, families, and providers. Hopefully this research would also encourage and reiterate the importance and value of survivorship programs. Finally, we should continue to seek creative solutions to address the other barriers to access that many patients face in order to give everyone the opportunity to engage in all desired aspects of a survivorship program.
While the perceived “end” of the cancer journey often brings joy and excitement about the future, many patients find that they feel as if their journey still continues after the last day of treatment. Luckily for us, the field is quickly reacting to this realization and—for the most part—wants to continue to walk with them as they keep moving forward.
Disclaimer : This disclaimer informs readers that the views, thoughts, and opinions expressed in the post belong solely to the author and contributors and not necessarily to the author’s employer, organization, committee, or other affiliations. The content in this post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this post.
Author: Becky Gold