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CME/CE

Cancer Survivorship: A Primer for Primary Care

  • Authors: Susan Buriak, MS, MPH; Jennifer Potter, MD; Puneet Sindhwani, MD
  • CME/CE Released: 5/16/2012
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 5/16/2013, 11:59 PM EST
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Target Audience and Goal Statement

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:

  1. Evaluate late effects of cancer treatment for survivors of breast, colorectal, and prostate cancer and non-Hodgkin lymphoma
  2. Identify psychosocial stressors and late effects faced by cancer survivors
  3. Identify available sources for surveillance and prevention guidelines applicable to survivors of breast, colorectal, and prostate cancer and non-Hodgkin lymphoma


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Susan E. Buriak, MS, MPH

    Doctoral Candidate, A.T. Still University of Health Sciences, School of Health Management, Kirksville, Missouri

    Disclosures

    Disclosure: Susan E. Buriak, MS, MPH, has disclosed no relevant financial relationships.

    Ms. Buriak does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Ms. Buriak does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Jennifer Potter, MD

    Associate Professor of Medicine, Harvard Medical School, Director, Women’s Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts

    Disclosures

    Disclosure: Jennifer Potter, MD, has disclosed no relevant financial relationships.

    Dr. Potter does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr. Potter does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Puneet Sindhwani, MD

    Director, Section of Renal Transplantation, Chief of Andrology and Male Infertility, Associate Professor and Chief of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

    Disclosures

    Disclosure: Puneet Sindhwani, MD, has disclosed no relevant financial relationships.

    Dr. Sindhwani does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr. Sindhwani does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor

  • Laurie Scudder, DNP, NP

    Clinical Editor, Medscape from WebMD

    Disclosures

    Disclosure: Laurie Scudder, DNP. NP, has disclosed no relevant financial relationships

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Nurse Planner

  • Laurie Scudder, DNP, NP

    Nurse Planner, Medscape LLC

    Disclosures

    Disclosure: Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 1.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

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*The credit that you receive is based on your user profile.

CME/CE

Cancer Survivorship: A Primer for Primary Care

Authors: Susan Buriak, MS, MPH; Jennifer Potter, MD; Puneet Sindhwani, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME/CE Released: 5/16/2012

Valid for credit through: 5/16/2013, 11:59 PM EST

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Survivors Speak

The Voice of Survivors

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This feature requires the newest version of Flash. You can download it here.

Scope of Survivorship

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:

  1. Acute survival — begins at diagnosis through treatment;
  2. Extended survival— begins with termination of treatment through surveillance and intermittent therapy; and
  3. Permanent survival — begins with remission through long-term secondary effects of treatment and the cancer experience.

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.

Essential Components of Survivorship Care

  • Prevention of recurrent and new cancers, and of other late effects
  • Surveillance for cancer spread, recurrence, or second cancers, assessment of medical and psychosocial late effects
  • Intervention for consequences of cancer and its treatment, for example medical problems such as lymphedema and sexual dysfunction; symptoms such as pain and fatigue; psychological distress and concerns related to employment, insurance, and disability
  • Coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met

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

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