Cancer survivors require quality care long after active phase of treatment

The cancer survivor population in the U.S. is nearing 14 million and is growing at a rate of about 10% each year. Unfortunately, cancer patients who have completed treatment do not always have access to comprehensive, follow-up care.

"Earlier detection and better treatment methods mean that two of every three adult cancer survivors are living five years after treatment," said Steven Castle, administrator of CJW Medical Center's Thomas Johns Cancer Hospital (TJCH) in Richmond, Va. "At TJCH, there are about 1,800 survivors finishing treatment each year."

The lack of follow-up care can result in suboptimal long-term outcomes, said Matthew P. Mumber, MD, a radiation oncologist with the Harbin Clinic in Rome, Ga. Very specific forms of followup care have a better chance of positively impacting a survivor's quality of life after treatment, Dr. Mumber added.

"A successful survivorship system must connect and engage the oncologist and the patient with the primary care physician. So often, primary care physicians are left out of the loop with potentially serious consequences." - STEVEN CASTLE

Dr. Mumber cited studies showing that behavioral and lifestyle changes can have a significant impact on the progression of prostate and colon cancer. One showed that diet and lifestyle changes were directly correlated with prostate cancer patients' ability to prevent the progression of their disease (J Urol 174: 1065-1069, 2005).

Another study found a significant increase in colon cancer recurrences and mortality among survivors with the highest intake of a high-fat western-patterned diet, with heavy consumption of red meat, sugary desserts, and refined grains (JAMA 298: 754-764, 2007).

Dr. Mumber advocated for "transformational" support that helps patients navigate through the physical, mental, emotional, and spiritual challenges involved in replacing old habits and patterns with newer, healthier ones. However, Dr. Mumber said that, in the current model for cancer treatment, there is little support for making the lifestyle changes that could positively impact survival.

According to Mr. Castle, cancer survivors receive highest quality care during the active phase of their treatment, but can be lost in transition to the more passive follow up phase of survivorship. "Sometimes patients may feel abandoned or lost after their last radiation or chemotherapy treatment or their last appointment with the surgeon," he said.

Dr. Mumber pointed out that "patients in the acute phase of being treated for cancer are helped through the use of technology, tests, and procedures. This is a 'top down' sort of treatment, with an expert using his or her clinical judgment to make important decisions and guide the process. During the survivorship phase, a more patient-centric approach that supports survivors' efforts to make important lifestyle changes is more likely to have an impact," he said.

Survivorship care can be organized into a multidisciplinary system. At TJCH, for instance, physicians have the option of either managing survivorship issues on their own or referring patients to the nurse practitioner, explained Tricia Cox, nurse practitioner with the survivorship program.

In addition, the survivorship care continuum must include the primary care physicians. "A successful survivorship system must connect and engage the oncologist and the patient with the primary care physician," Mr. Castle said. "So often, primary care physicians are left out of the loop with potentially serious consequences."

Survivors being followed at TJCH will soon receive secure access to their individual care plans over the Internet. "Having the plan online will enable two-way interaction between survivors and healthcare providers," Ms. Cox said. "Primary care physicians will also have a secure portal where they can view their patients' care plans and obtain information about post-treatment issues they may be experiencing."

The goal is to create a lifetime connection between survivors and healthcare survivors. "We see the survivorship program as a means to grow loyal patient relationships," Mr. Castle said. Meeting the demands of survivors for individualized follow-up care is likely to increase their satisfaction and their well-being. Furthermore, better follow-up care and earlier intervention when health problems do arise can lower the overall long-term cost of healthcare for survivors."

Source: 2010 Varian Medical Systems Survivorship Forum. The TJCH survivorship program utilizes Varian's Equicare CS survivorship management software.