Why Survivorship Matters: Creating Space in Multidisciplinary Cancer Care

Oncology care requires psychosocial support, nutrition, and survivorship, which can result in improved patient outcomes and quality of life.

Oncology treatment goes far beyond the drug regimens used to manage or attempt to cure the disease. Although the different therapies may be top of mind for most patients and clinicians, aspects such as psychosocial care, nutrition, survivorship, and sexual health should all be included in the larger conversation.

Experts from institutions and wellness centers across the US, including Memorial Sloan Kettering Cancer Center, Atrium Levine Cancer Institute, and George Washington Medical Faculty Associates, have discussed the all-encompassing factors in multidisciplinary cancer treatment. Throughout 2025, CancerNetwork and ONCOLOGY interviewed clinicians across the cancer care continuum about these important topics to gain valuable insights on integrating them into the day-to-day oncology practice.

“Most oncologists want the very best for their patients, but on a psychosocial level, delivering that care is challenging for so many reasons. We struggle with access to mental health care and limited training,” Daniel C. McFarland, DO, said. McFarland is director of the psycho-oncology program at Wilmot Cancer Center and a medical oncologist at University of Rochester Medicine in New York.

Focus on Survivorship

The National Cancer Institute (NCI) defines survivorship as “focus on the health and well-being of a person with cancer from the time of diagnosis until the end of life.”1 Contributing factors to survivorship include physical, mental, emotional, and financial effects.

As a pioneer in the field of survivorship, Declan Walsh, MD, chair of the Department of Supportive Oncology at Atrium Health Levine Cancer Institute in Charlotte, North Carolina, talked about the importance of this field and its involvement in the multidisciplinary treatment regimen. Walsh noted that Atrium Health uses the “loved one” standard: “If you had a family member who was [affected by] cancer, how would you want them to be looked after?” He added that this allows for initiatives such as the survivorship program to be developed and adapted.

Recently, Walsh has focused on developing and managing supportive oncology in major cancer centers. Although many institutions and community settings have the resources needed for supportive care, they may not be organized in a cohesive way for effective delivery.

“One important point to make is that many cancer centers already have a lot of supportive services being provided, [such as] counseling, support groups, nutrition, and palliative care for patients with cancer. [But] they’re not organized in a [proper] manner, and they’re not necessarily readily accessible to patients. The insight that we had here was that we could restructure, reorganize, and coordinate these services and programs much more effectively within a formal department of supportive oncology in the same way that you would have a department of radiation oncology or surgical oncology,” Walsh said.

Walsh noted that he and his team are integrating themselves into tumor boards to make their presence more noticeable and available. This will hopefully allow for earlier recognition of patient needs and more collaboration.

An area in supportive care that needs additional attention, Walsh noted, is nutrition. The research regarding what patients should eat before, during, and after cancer treatment has not been fully developed, he said.

“A huge proportion of patients with cancer in the US who are diagnosed this year will be either overweight or obese. That is a major issue in terms of, first, why somebody gets cancer. There’s also the issue of undernutrition, where people are losing weight. These are not uncommon problems. The majority of people now diagnosed [with cancer] are overweight or obese. Weight loss and severe weight loss are very common complications of cancer and cancer treatment, and they significantly change the outcome. Patients recognize this already, as a very common question when somebody’s diagnosed with cancer is, ‘What should I eat?’” We don’t have a very good answer for that, unfortunately, even though these issues are highly prevalent and highly impactful in the trajectory of the illness,” Walsh concluded.

Why Nutrition Matters

Nutrition during and after cancer treatment plays a critical role in helping patients regain or maintain their strength. Patients often experience malnutrition, significant weight loss, or severe adverse effects (AEs) that make it difficult or impossible to eat.

Denise B. Reynolds, RD, of Atrium Health Levine Cancer Institute, highlighted the nutritional difficulties she often sees in patients with cancer. “You will often hear me [tell patients to eat] small, frequent meals. A lot of times, patients are not able to eat a [large] volume of food. Eating a little bit throughout the day will help keep their nutrition level up, and it may help with the nausea,” she said.

The NCI classifies nausea or vomiting as part of the tumor-induced effects on nutritional status.2 Other AEs, such as mucositis or dysphagia, are categorized by treatment-induced effects, often from chemotherapy or radiation.

“The first thing is to try something soft, say, scrambled eggs or a chicken salad, vs a chicken breast. Something that is soft and moist will be a bit easier to [swallow]. Cold things soothe the mouth. [Many] times, we have patients who will hold ice in their mouth to help freeze that area a little bit, make it feel a bit more soothing. Rinsing the mouth out, keeping good oral care during that time [will help] if you are having sores in your mouth, which can lead to bacteria…and things like gingivitis and infections of the mouth,” Reynolds said.

Once a patient has completed treatment, Reynolds emphasized that it is vital to help them get back to a healthy weight and incorporate exercise into their plan. Her team at Atrium Health often references the American Institute for Cancer Research guidelines,3 which provide recommendations for weight gain/loss, tips for preventing secondary cancers, and healthy recipes.

Managing AEs With Oncodermatology

Dermatologic AEs involve the skin, hair, or nails. The Association of Cancer Care Centers provides numerous resources on how to manage these, including a guide for clinicians and patients.4 The guide notes that up to 50% of patients experience treatment interruption due to dermatologic AEs. Additionally, the guide provides a deep look into each dermatologic AE, how it is presented, and ways to manage the reaction.

Adam Friedman, MD, FAAD, professor and chair of dermatology, director of the residency program, and director of translational research at The George Washington University School of Medicine & Health Sciences in Washington, DC, talked about a recent paper he coauthored regarding how AEs are perceived and the knowledge base that patients with cancer have prior to treatment.5

The study showed that 52% of all respondents to a survey offered at 2 health fairs believed that anticancer therapies caused hair loss, compared with 31% who had previously been treated for cancer. Additionally, 47% of all respondents and 50% of those previously treated believed anticancer therapies caused dry skin/rash, and 41% vs 31%, respectively, believed anticancer therapies caused nail changes.

“I often have patients come to our supportive oncodermatology clinic, never being aware of, for example, the hair loss associated with chemotherapy. They were never told that that was a possibility, that either hair loss would be permanent or that when their hair grew back, it might grow back differently,” Friedman said.

The NCI website suggests ways to prevent mild skin and nail changes during treatment, such as using recommended skin products, preventing infections, moisturizing, and keeping nails cut short.6 Cirrhosis, dry skin, and hyperkeratosis are also AEs to look out for, Friedman said.

“I do like moisturizers with the indication for eczema on the bottle. It doesn’t mean it’s just for eczema. It falls under the FDA over-the-counter monograph that requires a certain percent of colloidal oatmeal, which is an FDA-recognized barrier protectant,” he said. “I recommend creams or ointments for more cracked, painful, and irritable skin. Ointments tend to be a little better tolerated. They don’t sting as much as a cream, based on what excipients go into them. When you use these, you want to apply them on damp skin to lock water into the stratum corneum where it’s needed for proper turnover.”

Friedman highlighted advancements occurring in the oncodermatology field that will impact the space, such as risk prediction. This allows clinicians to see patient demographics and determine whether the type of treatment they’re receiving, factoring in a patient’s comorbidities, will result in dermatologic AEs. FDA-approved medications are also a dire need, he noted. A topical prepatent for EGFR-associated papulopustular eruption is being investigated in a phase 2 clinical trial (NCT03115567).

“When you have an FDA-approved medication, it means you have a library of data that can guide decision-making, not to mention a database that you can sift through to go back to that first area of research, which is risk prediction, or maybe treatment response prediction as well,” Friedman concluded.

Assessing Mental Health Through Psycho-Oncology

McFarland identified a critical gap in the cancer care continuum regarding integrating psycho-oncology into everyday practice. During a collaborative podcast with CancerNetwork, he spoke with numerous colleagues and experts about the various parts of psycho-oncology.

Body Image

McFarland first discussed psycho-oncology with Michelle Fingeret, PhD, FAPOS, a clinical psychologist and founder of Fingeret Psychology Services in Bellaire, Texas. Fingeret, who specializes in body image and cancer, noted that oncologists observe body image issues in almost all patients.

“Body image is, at its core, the personal relationship someone has with their own body. It’s the way [patients] think, feel, and perceive their bodies, in all aspects of their bodies…. Any cancer survivor who goes through treatment is going to have something they’re going to have to adapt to, some sort of body image change. It’s a universal experience that all our patients will go through, and we need to be equipped to identify and help patients through that process,” she said.

According to Fingeret, there is an awareness around body image issues; however, taking the next step to address them is where clinicians often fall short.

For the American Psychosocial Oncology Society, Fingeret wrote a pocket guide on body image geared toward clinicians that outlines screening, evaluation, and treatment. She underscores the importance of normalizing and validating body image concerns so that patients will feel comfortable discussing the subject.7

Sexual Health

Next, McFarland spoke with Christian J. Nelson, PhD, chief of psychiatry service, attending psychologist, and codirector of the psycho-oncology of care and aging program at Memorial Sloan Kettering Cancer Center, regarding men’s sexual health after cancer treatment. Prostate, genitourinary, and even some gastrointestinal cancers can have an impact on men’s reproductive systems. The pair discussed how treatments for these cancers can also influence how a man perceives himself.

“The core of what it is to be a man, and men will talk about how whether it’s a loss of erections, other sexual aspects, loss of libido, or hot flashes, they’ll talk about how they just feel much less like a man…. Women can find their community. Women can connect with other women. Whereas men tend to pull away, they tend to withdraw, they tend not to disclose, and even if they do, they’re not going to sit around with their friends and [discuss it]. It’s a conversation that usually doesn’t happen unless it’s a group of men with prostate cancer talking about it. [Men] try to deal with this on their own, and these concerns aren’t discussed. They aren’t talked about,” Nelson said.

For men to be able to discuss sexual health issues and prepare for what’s ahead, they should know what to expect prior to receiving treatment, Nelson noted.

According to an article in the American Society of Clinical Oncology Educational Book, changes to sexual function occur in 40% to 85% of men with cancer.8 The study’s authors highlighted that, because of the impact on quality of life, conversations surrounding sexual health should be integrated into routine patient care.

McFarland asked Nelson how he approaches these conversations in a comfortable way for both the clinician and the patient. Nelson said that he will often ask, “Have these treatments impacted your sexual functioning in any way?” He will ask the patient for examples, such as whether they have noticed anything different about their orgasms or whether they have urine leak during sexual encounters.

Nelson noted that just because treatment has ended does not mean the patient does not need additional services. Although patients return for follow-up scans, there may not been enough time for emotional recovery.

“Maybe [patients] were trying to deny certain feelings to help get them through the experience. It’s somewhat of a traumatic experience. There’s emotional recovery that oftentimes patients say hits them after treatment…. Patients talk about how their friends will come up to them after treatment, saying, ‘You look great,’ ‘Congratulations, the treatments are done,’ or ‘You beat this.’ They’re saying to themselves, I have these [AEs]. I don’t feel great. I’m different than how I was before any cancer diagnosis, and that is a piece of the cancer experience,” Nelson concluded.

Mortality

One aspect of being an oncologist is having end-of-life discussions with patients. McFarland talked with his former mentor, William S. Breitbart, MD, an attending psychiatrist and the Jimmie C. Holland Chair in Psycho-Oncology at Memorial Sloan Kettering Cancer Center, about how to address these conversations.

“The primary emotion that we end up seeing, as a psychiatrist or as a psychologist or as an oncologist, is fear. Fear takes up all the oxygen in the room, and we think that fear is the only emotion related to death, and the whole idea of death and the emotions related to death are much more complex than we even think,” Breitbart said. “People are concerned about the process of dying…. People are afraid of the actual moment of dying. Then, people are concerned about existence. Will I cease to exist? Dying is more complex than just one thing.”

In a study published in the Journal of Clinical Oncology, investigators found that patients who had end-of-life or prognosis discussions with their oncologist had a better understanding of their disease.9 Of the 178 patients in the study, 10% reported recent discussions of the topic with their doctor, 38% reported past discussions, 13% reported recent and past discussions, and 38% reported they never had a discussion.

McFarland and Breitbart both noted the need to emphasize the true outcomes of a patient’s prognosis and provide them with an accurate description of what may occur. However, just having these discussions is an important step forward for patients with cancer.

“You cannot control everything. The Stoics had it right when they said, ‘Try to control the things you can control.’ Forgiveness is incredibly important, not just for patients to be able to forgive themselves, but for oncologists to be able to forgive themselves in areas where they may feel they could have done more or they didn’t do enough. Forgiveness is interesting in the sense that the philosopher Jacques Derrida paradoxically said, ‘The only thing that you can forgive is something unforgivable,’ ” Breitbart concluded.

Conclusion

When reviewing conversations about what is involved in cancer care, from treatment, physical health, nutrition, and dermatology, to mental health discussions about body image and end-of-life care, the bottom line is that oncology needs increased resources across the board. Having more visibility and utilizing the multidisciplinary cancer space will allow for seamless integration and a more patient-centered care approach.

Additional Resources

• Atrium Health Wake Forest Baptist Cancer Survivorship Clinic

• Mediterranean Diet and Cancer Prevention, American Institute for Cancer Research

• The Full Spectrum of Dermatology: A Diverse and Inclusive Dermatology Atlas, published in Journal of Drugs in Dermatology

• Oncology-on-the-Go podcast, hosted by Daniel C. McFarland, DO, and CancerNetwork

• Body Image and Psychosocial Resources, Fingeret Psychology Services

• Managing Anxiety and Prostate Cancer: Getting Your Life Back in the Front of Your Mind, presented by Christian J. Nelson, PhD, of Memorial Sloan Kettering Cancer Center

• Meaning-Centered Psychotherapy Training Program for Cancer Care Providers, Memorial Sloan Kettering Cancer Center

References

1. Survivorship. National Cancer Institute. Accessed October 14, 2025. https://tinyurl.com/36h7ceb4
2. Nutrition in cancer care (PDQ)-health professional version. National Cancer Institute. Updated September 20, 2024. Accessed October 14, 2025. https://tinyurl.com/y5cnmraf
3. Treatment tips: planning and preparing. American Institute for Cancer Research. Accessed October 14, 2025. https://tinyurl.com/25kbnzfc
4. Supportive care strategies for dermatologic toxicities. Association of Cancer Care Centers. Accessed October 14, 2025. https://tinyurl.com/52aab3nn
5. Skin and nail changes during cancer treatment. National Cancer Institute. Updated December 29, 2022. Accessed October 14, 2205. https://tinyurl.com/mr48xzpp
6. Menta N, Vidal SI, Whiting C, Azim SA, Desai S, Friedman A. Perceptions and knowledge of dermatologic side effects of anti-cancer therapies: a pilot survey. J Drugs Dermatol. 2025;24(8):e57-e58.
7. APOS psychosocial pocket guide. Body image. American Psychosocial Oncology Society. Accessed October 14, 2025. https://tinyurl.com/yc2vt37a
8. Agrawal LS, O’Riordan L, Natale C, Jenkins LC. Enhancing sexual health for cancer survivors. Am Soc Clin Oncol Educ Book. 2025;45(3):e472856. doi:10.1200/EDBK-25-472856
9. Epstein AS, Prigerson HG, O'Reilly EM, Maciejewski PK. Discussions of life expectancy and changes in illness understanding in patients with advanced cancer. J Clin Oncol. 2016;34(20):2398-2403. doi:10.1200/JCO.2015.63.6696