Cancer care: beyond survival

A systematic but individualised approach, which acknowledges and supports complex medical, social, and personal needs is required.


The Lancet 
Published:April 16, 2022
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Ringing the bell at the end of cancer treatment. Being given the “all clear” at the final clinic visit. 


This idea — of a clear endpoint to cancer treatment, after which normality resumes — is prevalent in our assumptions about what successful cancer treatment is, and can be a powerful motivation for people undergoing treatment, as well as those delivering and researching it. 


But for most people who survive cancer, the reality is not as straightforward. 


At least two-thirds of cancer survivors — either cured or in remission — have physical, psychological, and supportive care needs that are not well managed, and might not even be recognised by current models of care.
 

At least two-thirds of cancer survivors — either cured or in remission — have physical, psychological, and supportive care needs that are not well managed, and might not even be recognised by current models of care.


A three- part Series published in The Lancet today looks at the growing experience of cancer survivorship.


The authors describe the long-term effects and risks in patients who have had cancer, and the management of the most frequent clinical problems, including the care of the growing number of people treated for cancer during childhood and adolescence. 

Physical issues such as pain, fertility problems, and treatment-related health risks are common. 

Long-term psychosocial effects around sleep, fatigue, cognitive impairment, fear of recurrence, and concerns about relationships, finances, work, and education are also prevalent and under-addressed. 

For people who had cancer during childhood or adolescence, survivorship can last for decades, and while the risk of recurrence might fall over time, long-term treatment-related effects can accumulate. 

For people who had cancer during childhood or adolescence, survivorship can last for decades …

They might also have to contend with interrupted physical, emotional, social, or educational development and difficulties associated with the transition to adult care.

Cancer survivors’ experiences and needs are diverse. 

Evidence shows that tailored interventions are more effective than generic interventions; however, such interventions are not well supported in either oncology or primary care. 

A systematic but individualised approach, which acknowledges and supports complex medical, social, and personal needs is required.


…tailored interventions are more effective than generic interventions; however, such interventions are not well supported in either oncology or primary care.


A systematic but individualised approach, which acknowledges and supports complex medical, social, and personal needs is required.



The current model of cancer care — with a focus on the acute, active phase — serves patients poorly. Many survivors are discharged with ongoing problems. 


The current model of cancer care — with a focus on the acute, active phase — serves patients poorly.

Many survivors are discharged with ongoing problems.

The second Series paper by Michael Jefford and colleagues considers alternative models of care. 

They suggest that primary care-led models, shared care by oncologists and primary care providers, and nurse-led models are all supported by evidence as being safe, effective, sustainable, affordable, and acceptable to patients. 

The success of these alternative models, however, depends on clear communication and coordination between providers, to ensure that all those delivering care have the knowledge and experience required. 

The key requirement is a shift from detection of recurrence and new cancers, to a patient-centred model that identifies individual needs and risks, and that is sensitive and personalised enough to support survivors over the life course.


… primary care-led models, shared care by oncologists and primary care providers, and nurse-led models are all supported by evidence as being safe, effective, sustainable, affordable, and acceptable to patients.

Improved care delivery requires a fundamental shift in our goals for cancer control. 


Despite improvements in oncology research to better capture quality of life in patient outcomes, most studies still focus on survival endpoints.

Cancer treatments are often toxic and adverse events and long-term outcomes can be poorly described in many studies.

Under-recognition of these issues contributes to the unmet needs of survivors of cancer.

Improvement in monitoring longer-term function, psychosocial effects, and costs, along with patient involvement in research design and meaningful patient-centred outcome measures are needed.

Similarly, at a population level, many national targets are focused on cancer survival rates rather than more nuanced metrics reflecting positive and negative experiences of survivorship.

As a result, policy makers often lack the data to make informed improvements to information systems, insurance or reimbursement programmes, and national cancer control programmes.

Where resources are limited, survivorship is especially neglected and there is an urgent need for data on what survivorship care is available in low-income and middle-income settings, and international collaboration on locally driven research and care delivery.


With ageing populations, more effective treatments, and a greater focus on early cancer detection, there is now an unprecedented number of cancer survivors.

But many national cancer guidelines and services have not yet recognised that good cancer care extends well beyond diagnosis and treatment, even for those who are treated successfully.

This Series shows that, given the many advances in cancer care, our systems and our thinking must move from surviving cancer to living and thriving beyond it.

Originally published at https://www.thelancet.com.


A three- part Series published in The Lancet today looks at the growing experience of cancer survivorship.



SERIES: Cancer Survivorship

Management of common clinical problems experienced by survivors of cancer

Jon Emery, Phyllis Butow, Julia Lai-Kwon, Larissa Nekhlyudov,Meg Rynderman, Michael Jefford

Improved models of care for cancer survivors
Michael Jefford, Doris Howell, Qiuping Li, Karolina Lisy, Jane Maher, Catherine M Alfano, Meg Rynderman, Jon Emery

Long-term care for people treated for cancer during childhood and adolescence

Emily S Tonorezos, Richard J Cohn, Adam W Glaser, Jeremy Lewin, Eileen Poon, Claire E Wakefield, Kevin C Oeffinger


Originally published atThe Lancet, 16 April 2022, Volume 399, Issue 10334, Pages 1441-1572, e37


Explore the current issue of The Lancet, a world leading medical journal published weekly since 1823www.thelancet.com

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