With advances in treatment, supportive care, and early diagnosis, the prevalence of cancer is increasing. An individual is considered a cancer survivor from the time of diagnosis to the end of his or her life. 1 Although many patients with cancer are cured, they experience various short-term and long-term effects of cancer treatment, a high risk of recurrence and second cancer, anxiety, chronic pain, fatigue, depression, sexual dysfunction, and infertility. 1
As of January 1, 2014, there were about 14.5 million cancer survivors in the U.S. The most common cancers in this population include prostate (43%), colon and rectal (9%), and melanoma (8%) in males; breast (41%), uterine corpus (8%), and colon and rectal (8%) in females. 2 This estimate does not include noninvasive cancers, but does include bladder, basal cell, and squamous cell skin cancers. By January 1, 2024, the population of cancer survivors is predicted to increase to almost 19 million: 9.3 million males and 9.6 million females. 1 Most of the cancer survivors (64%) were diagnosed 5 or more years ago, and 15% were diagnosed 20 or more years ago. Nearly half (46%) of cancer survivors are aged ≥ 70 years, and only 5% are aged < 40 years. 2
Moye and colleagues reported that 524,052 (11%) of veterans treated in 2007 were cancer survivors. 3 The most common types of cancers among these veterans were prostate, skin (nonmelanoma), and colorectal cancers. Compared with the general population of cancer survivors in the SEER database, veteran survivors were older. 3 Because of the increasing prevalence of cancer survivors, greater attention is focused on long-term complications of cancer treatment. Recent studies have demonstrated that cancer survivors are less likely to receive general preventive care and care associated with noncancer-related medical conditions than are individuals without cancer. 4
Survivorship Care Components
In 2005, the Institute of Medicine (IOM) published From Cancer Patient to Cancer Survivor: Lost to Transition. 5 The report addresses 4 essential components of survivorship care: (1) prevention of recurrence, new cancers, and other late effects; (2) surveillance for cancer spread, recurrence, second cancers, and medical and psychosocial adverse events (AEs); (3) interventions for consequences of cancer and its treatment (medical problems, symptoms, psychological distress experienced by cancer survivors and their caregivers, and concerns related to employment, insurance, and disability); and (4) coordination between the specialist and primary care providers (PCPs) to ensure that all the survivors’ health needs are met. 5
Cancer Treatment Summary
To ensure better transition, the IOM recommended that survivorship plans be made with a summary of treatment provided by the primary oncologist who treated the patient, to improve communication among all health care providers and between the providers and the patient. 5 The summary should include the date of diagnosis; diagnostic tests; stage of diagnosis; a medical, surgical, and radiation treatment summary; and a detailed follow-up care plan. The IOM also recommends preventive practices to maintain health and well-being; information on legal protection regarding employment and health insurance; the availability of psychosocial services in the community; and screening for psychosocial distress in cancer survivors. 3,6 However, studies have shown that gaps in adherence with IOM recommendations exist even in dedicated survivorship centers. 7,8
