Promoting Quality Survivorship Care

Survivors must contend with the risk for cancer recurrence, effects of cancer treatment, and noncancer comorbidities. Most recurrences in stage II or III colon cancer occur within 3 years of diagnosis, with rates of recurrence declining with time (< 1.5% at 5 years and 0.5% at 8 years).^[98,99] Noncancer comorbidities may have more influence on overall QOL and long-term survival than the cancer diagnosis.^[100] Therefore, CRC survivor care should shift from surveillance for recurrence initially, to management of comorbidities and receipt of appropriate preventive care long-term. With most long-term survivors reporting at least 1 symptom attributed to previous cancer diagnosis or treatment and more than 70% of survivors having comorbid conditions, coordination of care is paramount for optimal care of cancer survivors to prevent functional decline and ensure receipt of necessary care for both cancer and noncancer conditions.^[20]

Follow-up remains intensive after curative treatment for CRC, with increasing visits to primary care physicians (PCPs) and decreasing visits to oncologists over time.^[101-103] Although survivors followed up only by a PCP did not perceive lower quality of care, PCPs reported significant uncertainty about surveillance protocols and side effects of treatments, and dissatisfaction with the transfer of care of survivors.^[102,104] CRC survivors may receive less health behavior counseling and care for comorbid conditions than adults without cancer, and are more likely to experience an avoidable health outcome.^[100,105] In addition, although receipt of preventive care is high in the early years after diagnosis, rates decreased after 5 years in CRC survivors.^[101] Survivors followed up by a PCP and an oncologist had the highest likelihood of receiving both preventive care (influenza vaccination, bone densitometry, and lipid monitoring) and cancer surveillance (colonoscopy, cervical cancer screening, and mammography).^[100,101]

A shared model of care is ideal for survivorship care and may be facilitated by a survivorship care plan.^[106] In this plan, late effects (those that may occur in the future) and long-term effects (residual effects from treatment not expected to improve) can be delineated. The plan should be completed at the end of primary treatment by oncology providers, and include a summary of treatment received, a description of the plan for surveillance of cancer recurrence, ways to address the chronic physical and psychosocial effects of cancer, and necessary lifestyle and preventive care measures appropriate for individual survivors.^[10,107]