Friday, March 24, 2023
This activity is intended for primary care physicians, nurse practitioners, physician assistants, and other healthcare professionals, including nurses, who provide care to cancer survivors.
The goal of this activity is to increase awareness of Institute of Medicine (IOM) recommendations for cancer survivorship planning and survivor care and provide relevant clinical content for primary care clinicians.
Upon completion of this activity, participants will be able to:
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CME/CE Released: 5/16/2012
Valid for credit through: 5/16/2013
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The Voice of Survivors
The scope of survivorship has been defined by the National Cancer Institute (NCI) as “survivorship covers the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life. It focuses on the health and life of a person with cancer beyond the diagnosis and treatment phases. Survivorship includes issues related to the ability to get health care and follow-up treatment, late effects of treatment, second cancers, and quality of life”.[1]
The seasons of survival as noted in the Institute of Medicine (IOM) report,[2] first described by Mullan as relevant to cancer survivorship, comprise 3 phases:
The crux of survivorship are the concepts of “with,” “through,” and “beyond.”[3] This is the trajectory that the IOM encourages healthcare providers to focus on with regard to cancer survivors.[2]
The number of cancer survivors grows each day. According to The American Cancer Society (ACS) the number of cancer survivors in the United States is approaching 12 million.[4] Five-year relative survival data from the Surveillance, Epidemiology, and End Results (SEER) for all cancer sites and combining race and gender calculates a 66.7% rate of remission.[5] The number of cancer survivors is expected to double by 2050.[6,7]
The IOM was the flagship organization raising awareness about cancer survivorship and provided guidance on the essential components of care in the seminal report From Cancer Patient to Cancer Survivor: Lost in Transition.[2] In this report, the IOM posed 4 essential components of survivorship care as recommendations for advocacy, education, and clinical practice.
Other efforts include a joint venture between the Centers for Disease Control and Prevention (CDC) and the Lance Armstrong Foundation (LIVESTRONG), for a National Action Plan for Cancer Survivorship. The action plan summarized and prioritized 4 core cancer survivorship needs: surveillance, education, policy/infrastructure and access to care. The primary goal of the National Action Plan is to raise survivorship awareness and approach cancer survivorship as a public health concern.
The landmark IOM report resulted in 10 recommendations to address the ongoing needs of survivors. The top priorities are to raise the general awareness of cancer survivorship and provide guidance on the essential components of care, including survivorship care planning. In order to facilitate these changes, the IOM asserted that the interface from and between clinical subspecialists and primary care clinicians was key.
Primary care providers will play a key role in caring for the increasing numbers of survivors. The shortage of oncologists is a stark reality and the nature of the work (surveillance, screening, looking holistically at the individual and her/his social environment) falls perfectly into the purview of the generalist. Nekhlyudov and Greenfield have suggested generalists communicate with oncologists to improve transitions of care.[8] Increased awareness and acceptance of survivorship care plans is key to this improved care model.
The goal of this activity is to provide an overview of survivorship for the most prevalent cancers. Additionally, information about non-Hodgkin lymphoma (NHL) is included due to a notable quality of life burden with this cancer. Each disease condition is summarized in terms of descriptive epidemiology, important from the perspective of survivorship as a public health concern.
The lifetime risk for being diagnosed with cancer in the United States is about 50% for a man and 33% for a woman.[9] The age-adjusted incidence rate for all races, both genders, for all cancer sites is 478.1 per 100,000 (95% CI, 477.8-478.4).[10] Sixty-six percent of those diagnosed with cancer today can expect to be alive 5 years from now.[11]
Table 1: Prevalence of Survivors Alive in 2008
| Cancer Site | Estimated Percentage of Total Survivors |
|---|---|
| Breast (2,632,005) | 22% |
| Prostate (2,355,464) | 19% |
| Colorectal (1,110,077) | 10% |
| NHL (454,278) | 4% |
The total number of cancer survivors is estimated to be 11.7 million (2007 data).[17]
SEER(9) Fast Stats. http://seer.cancer.gov/faststats/selections.php
