The prevalence of cancer survivors is increasing worldwide. This creates the imperative to look beyond cancer survival to cancer survivorship. This review explores cancer survivorship from an ...international perspective in two ways: from a cancer control perspective through a review of cancer control strategies and from a cancer care perspective through a review of clinical practice guidelines and research on cancer follow-up care.
Many national cancer control strategies or cancer charities consider survivorship obliquely, primarily under the umbrellas of quality of life and rehabilitation. Few have well-developed policies or plans specifically directed at survivorship. Cancer follow-up care is recognized internationally as a pressing health care issue. Many countries have tested new and innovative models to deliver follow-up care. Similarly, many countries have developed guidelines that specifically address follow-up care. Few studies or guidelines address the broader, multifaceted aspects of cancer survivorship.
This review suggests that research and recognition of cancer survivorship as a unique phase of the cancer care trajectory need to be improved. In many of the poorer countries of the world, the imperative remains the basics of cancer care: timely diagnosis, access to treatment, and alleviation of suffering.
To provide recommendations on the follow-up and management of patients with breast cancer who have completed primary therapy with curative intent.
To update the 2006 guideline of the American Society ...of Clinical Oncology (ASCO), a systematic review of the literature published from March 2006 through March 2012 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed the evidence to determine whether the recommendations were in need of updating.
There were 14 new publications that met inclusion criteria: nine systematic reviews (three included meta-analyses) and five randomized controlled trials. After its review and analysis of the evidence, the Update Committee concluded that no revisions to the existing ASCO recommendations were warranted.
Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter. For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy. Thereafter, unless otherwise indicated, a yearly mammographic evaluation should be performed. The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed tomography scans, (18)Ffluorodeoxyglucose-positron emission tomography scans, magnetic resonance imaging, and/or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.
Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, ...there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.
A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.
A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 +/- 2.3 years had elapsed for prostate cancer, 2.6 +/- 2.6 years for colorectal cancer, 2.8 +/- 2.5 years for breast cancer, and 3.2 +/- 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.
With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
An Institute of Medicine report recommends that patients with cancer receive a survivorship care plan (SCP). The trial objective was to determine if an SCP for breast cancer survivors improves ...patient-reported outcomes.
Women with early-stage breast cancer who completed primary treatment at least 3 months previously were eligible. Consenting patients were allocated within two strata: less than 24 months and ≥ 24 months since diagnosis. All patients were transferred to their own primary care physician (PCP) for follow-up. In addition to a discharge visit, the intervention group received an SCP, which was reviewed during a 30-minute educational session with a nurse, and their PCP received the SCP and guideline on follow-up. The primary outcome was cancer-related distress at 12 months, assessed by the Impact of Event Scale (IES). Secondary outcomes included quality of life, patient satisfaction, continuity/coordination of care, and health service measures.
Overall, 408 survivors were enrolled through nine tertiary cancer centers. There were no differences between groups on cancer-related distress or on any of the patient-reported secondary outcomes, and there were no differences when the two strata were analyzed separately. More patients in the intervention than control group correctly identify their PCP as primarily responsible for follow-up (98.7% v 89.1%; difference, 9.6%; 95% CI, 3.9 to 15.9; P = .005).
The results do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes. Transferring follow-up to PCPs is considered an important strategy to meet the demand for scarce oncology resources. SCPs were no better than a standard discharge visit with the oncologist to facilitate transfer.
Friends Grunfeld, Eva
Canadian Medical Association journal (CMAJ),
08/2022, Volume:
194, Issue:
31
Journal Article
Peer reviewed
Grunfeld reflects on her friendship with a Muslim female obstetrician from Syria. She states that according to the accepted truths of geopolitics, they are enemies. She is Muslim from Syria, a ...country that is hostile to the state of Israel. She, on the other hand, is Jewish and her parents went to Israel for refuge as displaced persons from a Nazi concentration camp. She has been through hell and witnessed the ravages of hell through her parents' stories and lives. Refugee camp/concentration camp, refugees/displaced persons, escape, hell. But, geopolitics and their respective experiences of the hell they can inflict, are subjects of conversation for another day.
