Citing shortfalls in the care currently provided to the country's 10 million cancer survivors, a new report recommends that each cancer patient receive a "survivorship care plan."
The report, by the Institute of Medicine and National Research Council of the National Academies, says such plans should summarize information critical to the individual's long-term care, such as the cancer diagnosis, treatment, and potential consequences; the timing and content of follow-up visits; tips on maintaining a healthy lifestyle and preventing recurrent or new cancers; legal rights affecting employment and insurance; and the availability of psychological and support services. The committee that wrote the report also called for new evidence-based clinical guidelines and standards to assure the quality of care given to cancer survivors, as well as for better coordination between specialists and primary care providers.
"There is currently no organized system to link oncology care to primary care," said committee chair Sheldon Greenfield, professor of medicine and director of the Center for Health Policy Research, University of California, Irvine. "Successful cancer care doesn't end when patients walk out the door after completion of their initial treatments."
In the United States, half of all men and one-third of all women will develop cancer in their lifetimes. Advances in the detection and treatment of cancer, combined with an aging population, mean greater numbers of cancer survivors in the near future, the report notes. Despite the increase in survivors, however, primary care physicians and other health care providers often are not extremely familiar with the consequences of cancer, and seldom receive explicit guidance from oncologists, the committee found. Furthermore, the lack of clear evidence for what constitutes best practices in caring for patients with a history of cancer contributes to wide variation in care.
Besides being at risk for cancer recurrence and for developing other cancers, survivors also may face psychological distress, sexual dysfunction, infertility, impaired organ function, cosmetic changes, and limitations in mobility, communication, and cognition. Some of this is due to the fact that most cancer treatments -- including surgery, chemotherapy, hormone therapy, and radiation therapy -- can have long-term effects on tissues and organ systems.
"Unfortunately, many critical aspects of cancer survivors' needs are lost somewhere between active treatment and long-term follow-up, which is why we call for every patient to be given a summary of their cancer treatment and a description of follow-up care needed," said committee vice chair Ellen Stovall, a 34-year cancer survivor and president of the National Coalition for Cancer Survivorship. Such plans should be written by oncology providers and thoroughly discussed with patients, and the cost should be covered by insurers. The concept of a cancer survivorship plan was previously suggested by the President's Cancer Panel.