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Defining Cancer Survivorship
Estee Fleischman, B.A., Andrea Kronman, MD, MSc
Section of General Internal Medicine, Women’s Health Research Unit
Background
Increasing Number of Cancer Survivors
 11.7 million people (2007 CDC)
 Due to earlier detection, improved therapies, effective medical management, and
increasing age of the population.
 Important to characterize the type and frequency of medical care utilized by
cancer survivors in order to meet health needs and to curb increasing healthcare
costs.
Defining Cancer Survivorship

Lack of a consistent definition in literature

Important to define a growing patient population that is actively being studied

Need to standardize the definition for research studies.
Objective
To perform a literature review that forms the basis of defining “cancer survivor” at
BMC. This variable definition will be used in a health services and epidemiological
retrospective chart review study of ED use of cancer survivors at BMC.
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Descriptive Analysis
 Categorized variable definitions used in different studies
 Computed frequencies for different definition categories
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Conclusions
Studies use a wide range of definitions that are most appropriate for them.
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The most used operational definition for cancer survivorship was ≥5 years post diagnosis.
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Based on the results, the use of a standard definition of ≥5 years post diagnosis should be used to
define cancer survivorship to allow enough time for treatment and acute complications.
Results
Cancer Survivor Definition
Number of studies using this definition
After diagnosis
5
> 5 years post diagnosis
Methods
Systematic literature review to determine a definition of cancer survivorship that could be used in this
study
MESH terms and key phrases: Cancer survivor, cancer survivorship, especially in health services
research studies – ED utilization, mood disorders
Reviewed definitions used by studies that included cancer survivors as a study population.
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Limitations
Looked mostly at cancer survivor studies within health services research – specifically ED utilization,
healthcare services utilization, mood disorders.
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Didn’t have a defined protocol for performing each search within the literature search.
Implications
These findings suggest that researchers use a definition of cancer survivorship that is appropriate for
their study but that ≥5 years post diagnosis was the most used definition.
12
> 1 year post cancer diagnosis
1

2-5 years post cancer diagnosis
1

short term < 5 years post diagnosis, long-term 5-10
years post diagnosis
1
recent diagnosis <1 year, intermediate diagnosis 1-6 1
years, remote history of cancer >6 year
Due to this variability, a definition of ≥5 years post diagnosis should be used as the standard definition
or the methods section should include a clear explanation of their specific definition.
References
Centers for Disease Control and Prevention (CDC). Cancer survivors – United States, 2007. MMWR
2011;60(9):269–272.
Feuerstein, M. Defining Cancer survivorship. 2007. Journal of Cancer Survivorship: 1 (1): 5-7.
Poorly defined (lacks clear timeline)
9
Khan, NF. Et al. Defining cancer survivorship: a more transparent approach is needed. 2011. Journal of
Cancer Survivorship. Electronic publication.
Total
30
Acknowledgement: This work was supported by the Boston University Medical Student Summer Research Program.
Studies Reviewed
Ashing-Giwa 2004, Understanding the breast cancer experience of women: a qualitative study of
African-American, Asian American, Latina and Caucasian cancer survivors
Baldwin 2011, Receipt of General Medical Care by Colorectal Cancer Patients: A Longitudinal Study
Barbera 2010, Why do patients with cancer visit the emergency department near the end of life?
Beckjord 2008, Health-related information needs in a large and diverse sample of adult cancer
survivors: implications for cancer care
Bennett 2010, Time since diagnosis as a predictor of symptoms, depression, cognition, social
concerns, perceived benefits, and overall health in cancer survivors
Deimling 2005, The health of older-adult, long-term cancer survivors
Dieluweit 2011, Utilization of Psychosocial Care and Oncological Follow-Up Assessments Among
German Long-Term Survivors of Cancer with Onset During Adolescence
Earle 2007, Mental health service utilization among long-term cancer survivors
Fortner 2002, A survey of pain-related hospitalizations, emergency department visits, and physician
office visits reported by cancer patients with and without history of breakthrough pain
Fossa 2003, Fatigue, Anxiety, and Depression in Long-Term Survivors of Testicular Cancer
Gao 2010, Psychological distress in cancer from survivorship to end of life care: prevalence, associated
factors and clinical implications
Goytia 2009, Establishing a general medical outpatient clinic for cancer survivors in a public city
hospital setting
Hewitt 2002, Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National
Health Interview Survey
Hewitt 2003, Cancer survivors in the United States: age, health, and disability
Hoffman 2009, Psychological distress in long-term survivors of adult-onset cancer: results from a
national survey
Hudson 2009, Breast, colorectal and prostate cancer screening for cancer survivors and non-cancer
patients in community practices
Kazak 2010, Psychological outcomes and health beliefs in adolescent and young adult survivors of
childhood cancer and controls
Khanna 2011, Prevalence, Healthcare Utilization, and Costs of Breast Cancer in a State Medicaid Feefor-Service Program
Kurtz 2005, Utilization of services among elderly cancer patients-relationship to age, symptoms,
physical functioning, comorbidity, and survival status
Mols 2007, Health-related quality of life and health care utilization among older long-term cancer
survivors: a population-based study
McCorkle 2006, Factors Related to Depressive Symptoms Among Long-Term Survivors of Cervical
Cancer
Nord 2005, Self-reported health and use of health care services in long-term cancer survivors
Oeffinger 2004, Health care of young adult survivors of childhood cancer: a report from the Childhood
Cancer Survivor Study
Richardson 2007, Ambulatory care for cancer in the United States: results from two national surveys
comparing visits to physicians' offices and hospital outpatient departments
Seitz 2010, Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in
adolescence
Seo 2004, Effects of cancer history and comorbid conditions on mortality and healthcare use among
older cancer survivors
Synder 2009, Prevention, screening, and surveillance care for breast cancer survivors compared with
controls: changes from 1998 to 2002.
Townsend 2009, Health and well-being in older married female cancer survivors
Wagner 2000, Healthcare utilization among Hispanics: findings from the 1994 Minority Health Survey
Yu 2007, Physician visits, patient comorbidities, and mammography use among elderly colorectal
cancer survivors