Cancer Survivorship and Models of Survivorship Care

Abstract

There are over 13 million cancer survivors in the United States. This is heterogenous group in age, cultural background, and cancer history and also in regards to the natural history of their cancer survivorship. There are "seasons of survivorship" including acute, transitional, extended, permanent, and chronic in which the medical and psychosocial problems and needs of cancer survivors change. For example, the medical and psychosocial needs of a testicular cancer survivor who is 1 year beyond diagnosis are very different from the same person 20 years later when the risk of recurrence is very low but the risk of second cancers has risen. This is a review of the "seasons of survivorship." Some of the specific needs of cancer survivors in each phase of survivorship are presented. Models of survivorship care are also reviewed.

A model of identity grounded in the acute season of survivorship

“…This study connects these phenomena to engagement in the health care recipient domain through a framework of identity. The importance of routine to the identity of the participants raises important questions about how interventions that support routine might promote psychological well‐being throughout the cancer experience . Additionally, while multiple studies have characterized what information patients identify as desirable, this study suggests that information needs early in the cancer journey are, at least in part, related to planning how to re‐establish and maintain routine.…”

Defining cancer survivor and cancer survivorship: The who, what, and when

“…There is also a lack of consensus surrounding the definition of "cancer survivorship," a term often used in tandem with "cancer survivor." Though authors of recent reviews have provided excellent summaries on key concepts related to cancer survivors and cancer survivorship (3,4) , they have not clearly proposed updated definitions of cancer survivor and cancer survivorship based on the literature. In order to move forward in our understanding and ability to determine meaningful intervention targets and outcomes for cancer survivorship care, global consensus should be reached regarding evidence-based definitions of cancer survivor and cancer survivorship.…”

“…At diagnosis, some may face an "existential crisis"; when primary treatment has ended, individuals may experience other long-term concerns (e.g., health, receipt of quality health care following treatment, functional changes, lifestyle changes) (51) . Ability to work also changes throughout the trajectory, with the majority of cancer patients who worked before their diagnosis being able to return following treatment (4,51) . At all of these points, cancer patients need to "survive" and "thrive" through each of the (often changing) issues confronting them.…”

“…Despite problems regularly faced by cancer patients following treatment (35) , they often transition into a phase including isolation and less involvement from their medical team (4) . Among patients (30%) who report five or more unmet needs at the end of treatment, 60% said that those needs were still unmet at six months (52) .…”

“…Improved communication about long-term care expectations from clinicians during treatment may aid in preventing misunderstandings among cancer patients and help them to better navigate the health care system during follow-up. Multidisciplinary and integrated clinics (4) are two models of survivorship care which may help to create a sense of shared responsibility for the cancer survivor and improve access to clinicians best equipped to address the changing needs of cancer patients through the different stages of survivorship.…”