Addressing Post-Acute/Late Effects and Other Cancer Survivorship Care Gaps

At the 2024 Annual Oncology Clinical Practice and Research Summit, Andrew M. Evens, DO, MBA, MSc, spoke with CancerNetwork^® about strategies for potentially addressing current gaps in care for survivors of cancer. He discussed these gaps in the context of a presentation he moderated at the meeting, in which other expert panelists from his institution highlighted ongoing initiatives to improve cancer survivorship care.

Evens is the deputy director for Clinical Services at Rutgers Cancer Institute and the system director of Medical Oncology and the oncology lead at RWJBarnabas Health Medical Group. He is also the associate vice chancellor for Clinical Innovation and Data Analytics at Rutgers Biomedical and Health Sciences.

According to Evens, cancer survivors may become “lost in transition” as they move away from pediatric care and switch to receiving treatment from an adult oncologist. Additionally, survivors of cancer may experience post-acute or late effects such as organ, cardiac, or lung disease following prior treatment with chemotherapy or radiation. Evens highlighted a need to better understand the post-acute and late effects among each cancer survivor while considering the use of alternative screening strategies to improve post-survivorship care.

Transcript:

There’s a lot of gaps of care [for cancer survivors], and you can look at it through a couple different lenses. One is that we often think of patients as being lost in transition. And [when] I mean by transition, it could be a few different ways. One is about transitioning from pediatric to adulthood [survivorship], and that transition from their pediatric oncologist to an adult oncologist. Then, regardless of age, the tip of our spear for many cancers is to hopefully treat [the patient and] cure the cancer. What happens years later or decades later? What’s that transition of care when still seeing the treating oncologist, and how do we deliver that survivorship care?

The good news is there is somewhat of an increased effort to study this and to understand it. We know that— unfortunately, in cancer—[for] many cancer survivors, there can be what’s called post-acute or late effects. Post-acute means 1 to 10 years after treatment, and late effects mean after 10 years. In some studies, [there] could sometimes be an exponential increase in other organ disease, like cardiac disease, lung disease, or increased infections partly related to the prior chemotherapy or radiation. It’s [about] understanding for an individual patient who received their treatment. What are those post-acute and late effects? And importantly, what do we do about it? Should they have different screening or more enhanced screening? Who should deliver that post-survivorship care?

Reference

Evens A, Cole P, Ligresti L, Manne S. Cancer survivorship: scale, scope, and partnerships for patient-centered care. Presented at the 2024 Annual Oncology Clinical Practice and Research Summit; November 15-16, 2024; New Brunswick, NJ.