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Cancer Survivorship Care
[Insert Presenter Name
Insert Presenter Institution]
Objectives
• Define survivorship and describe the need for
survivorship care
• Discuss the Commission on Cancer standards
for implementing survivorship care planning
• Identify the key components of a cancer
survivorship care
• List patient and health care professional
educational resources
Survivorship
• What is survivorship?
– NCI definition
• Health and life of individual from end of
treatment until the end of life
• Covers physical, psychosocial and economic
issues
• Includes access to care and follow-up treatment,
late and long-term effects of treatment, second
cancers and quality of life
• Includes family, friends and caregivers
NCI, 2014
The Need for Survivorship Care
• Rapidly growing population of survivors
• Survivors experience unmet physical,
psychosocial, practical and spiritual needs
• Inconsistent coordination of care and
communication between oncologists and
primary care providers
• Significant long-term and late effects
• Complexity of care, co-morbid conditions
Cancer Survivor Needs
Ferrell & Grant, 2004, reproduced
with permission in the American
Cancer Society’s Cancer Treatment &
Survivorship Facts & Figures, 2012
Common Long-Term /
Late Effects by Treatment Type
Treatment
Long-term side effects
Late side effects
Chemotherapy
Fatigue
Premature menopause
Sexual dysfunction
Neuropathy
“Chemo brain”
Kidney failure
Vision/cataracts
Infertility
Liver problems
Lung disease
Osteoporosis
Reduced lung capacity
Second primary cancers
Radiation therapy
Fatigue
Skin sensitivity
Lymphedema
Cataracts
Cavities and tooth decay
Cardiovascular disease
Hypothyroidism
Infertility
Lung disease
Intestinal problems
Second primary cancers
Surgery
Sexual dysfunction
Incontinence
Pain
Body image disturbance
Functional disability
Infertility
IOM , 2006, Mayoclinic.com
Cancer and Comorbidities
Psychosocial Stress
(anxiety, depression,
insomnia, cognitive
deficiency)
Heart Disease,
Hypertension,
Stroke
Cancer
Arthritis
Emphysema,
Asthma, COPD
Osteoporosis
Diabetes
Overweight /
Obesity
Smith et al, 2008.
Psychosocial Late Effects
• While only a significant minority of cancer
survivors will meet criteria for a mental
health disorder, the majority of survivors
will experience psychosocial distress at a
level that is significant, but does not meet
criteria for a psychiatric disorder
Institute of Medicine Report
In 2006, the IOM issued a
groundbreaking report that
described core
components of
survivorship care and
recommended a treatment
summary and follow up
care plan be given to every
cancer patient. Also, the
plan should be clearly
explained.
IOM, 2006.
CoC Standard 3.3:
Survivorship Care Plan
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Contact info of treating institutions/providers
Diagnosis, stage
Treatment modality and details
Need for adjuvant therapy and details
Long-term and late effects
Schedule of follow up visits, tests & screening
Information on emotional health & physical
wellness
Survivorship Care Plans
© American Society of Clinical Oncology
Used with permission
Source: http://www.cancer.net/survivorship/follow-care-after-cancertreatment/asco-cancer-treatment-and-survivorship-care-plans
Source: LIVESTRONG Foundation:
www.LIVESTRONG.org
Basic Elements of
Survivorship Care
Prevention of cancer
and late effects
Surveillance for
recurrence screening for
new cancers
Identification of
interventions for
consequences of cancer
and its treatment
Coordination between
oncology specialists and
primary care providers
IOM, 2006
Importance of Follow Up Care
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Prostate Exams
Colonoscopy
Mammograms
Pap smear
Skin checks
Lung screening
(if indicated)
• Thyroid exam
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Lipid checks
Blood sugar check
Blood pressure
Vaccinations
Bone density
checks
• Weight check
• Distress screening
LIVESTRONG Essential Elements
Source: LIVESTRONG Foundation:
www.LIVESTRONG.org
Patient Education Resources
Patient Education Resources
Online Academy
Executive Training on Navigation and
Survivorship
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Covers the nuts and bolts of
navigation and survivorship
program development and
implementation
CE credits for nurses and social
workers
tinyurl.com/GWOnlineAcademy
Cancer Survivorship
E-Learning Series
Cancer Survivorship Clinical
Practice Guidelines
National Comprehensive
Cancer Network
• By topic: anxiety and
depression, cognitive
function, exercise, fatigue,
immunizations and
infections, pain, sexual
function (female/male),
sleep disorders
American Society of Clinical
Oncology
• By topic: neuropathy,
fatigue, anxiety and
depression, fertility
preservation
American Cancer Society
Survivorship Care Guidelines
for Primary Care Providers
• Holistic: Surveillance,
screening, long term and
late effects, health
promotions
• Prostate currently available
• Breast, Colorectal, Head &
Neck to be released in
2015
References
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Commission on Cancer (CoC). Accreditation Committee Clarifications for Standard
3.3 Survivorship Care Plan, 2014.
Ferrel B & Grant M. City of Hope, Beckman Research Institute, 2004.
GW Cancer Institute. Breast Cancer Survivorship in Washington, DC: A Gap Analysis
and Recommendations for Action. Unpublished Report, 2014a.
GW Cancer Institute. Oncology Patient Navigator Core Competencies, 2014b.
Institute of Medicine (IOM). From Cancer Patient to Cancer Survivor: Lost in
Transition, 2006.
LIVESTRONG Foundation. The Essential Elements of Survivorship Care: A
LIVESTRONG Brief, 2011.
Mayo Clinic. Cancer Survivors: Late Effects for Cancer Treatment. n.d.
http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancersurvivor/art-20045524
National Cancer Institute. Facing Forward: Life After Cancer, 2014.
Smith A et al. Cancer, Comorbidities and Health-Related Quality of Life of Older
Adults. Health Care Finance Review, 2008.
Questions?
[Insert contact information of presenter]