Survivorship needs grow and diversify
Optimizing care for cancer survivors and better involving them in long-term surveillance and care has become increasingly important as the numbers continue to climb. "The number of cancer survivors is larger than ever, and as U.S. boomers become 65 years and older, there will be a tsunami of more cancer survivors, Dr. Alfano predicted.
"This huge tsunami [of cancer patients] is coming over the next decade, and we are completely unprepared. We have done a poor job of understanding the needs of adult cancer survivors," she warned. "There is a scramble underway now to understand what adult cancer survivors need."
For example, cardiovascular adverse effects from several different cancer treatments often occur many years after treatment. "Usually, these patients are not in surveillance anymore," said Dr. Thomas M. Suter of the Swiss Cardiovascular Centre in Bern, Switzerland. "No one is looking at these patients. They need to be on medical treatment to improve their prognosis," such as treatment with an angiotensin-converting enzyme inhibitor, he said in his talk at the meeting.
Another shortcoming of U.S. cancer survivor care is the fragmented care many patients receive and a glaring lack of coordination.
U.S. cancer survivors "wind up seeing multiple providers for late effects like cardiovascular disease, osteoporosis, and diabetes, which is on top of their surveillance for a recurrence of their primary cancer or appearance of a second primary cancer," said Dr. Alfano. "We have to create a more coordinated form of care that is truly team based to make it easier for patients and relieve the huge burden on them and their families. I hear from cancer survivors and families all the time that it takes hours each week just to coordinate a cancer patient’s care. We need to ease this burden. We have done a poor job understanding the needs of adult cancer survivors."
An especially pressing need is for information on lifestyle change, said Dr. Alfano. "Cancer survivors are looking for things they can do personally to take control back over their morbidity and mortality."
Cancer patients are often highly motivated to take steps to cut their risk of treatment-related adverse outcomes, recurrence, or development of a second primary cancer. In 2012, the American Cancer Society issued nutrition and physical activity guidelines for cancer survivors (CA Cancer J. Clin. 2012;62:30-67), noted Dr. Kevin D. Stein, managing director of the behavioral research center of the ACS in a talk at the meeting.
"We’ve done a poor job of getting lifestyle-change information to cancer survivors. We need to include lifestyle change as part of survivorship plans," said Dr. Alfano.
Despite the shortcomings in survivorship planning in the United States and United Kingdom, it outstrips what currently occurs in most of Europe. "We are far behind the United States," said Dr. Elizabeth Charlotte Moser, professor at the Champalimaud Foundation in Lisbon and chair of the EORTC Survivorship Task Force.
In addition to having Europe follow the United Kingdom and United States in expanding survivor planning, she anticipates a contribution from several European-based cancer-treatment trials for which long-term follow-up data are available. For example, six EORTC-sponsored trials in patients with either early-stage breast cancer or ductal carcinoma in situ together enrolled more than 20,000 patients starting in 1986. EORTC researchers are planning to collect long-term outcome data from as many of these patients as can be tracked down, Dr. Moser said.
Dr. Maher, Dr. Alfano, Dr. Stein, and Dr. Moser said they had no disclosures. Dr. Suter said that he has been a speaker on behalf of Roche, RoboPharma, and Novartis.
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