With Paolo Tralongo, MD; Mary S. McCabe, RN, MN; and Antonella Surbone, MD, PhD, FACP
By Sarah DiGiulio
The field of cancer survivorship care has grown significantly in the past 2 decades—yet there are still many very real challenges in the delivery of cancer survivorship care and meeting the needs of cancer survivors. That's the bottom line from three experts in the field: Paolo Tralongo, MD, Chief of the Medical Oncology Division at RAO Umberto I Hospital, Siracusa, Italy; Mary McCabe, RN, MN, Director of the Cancer Survivorship Initiative at Memorial Sloan Kettering Cancer Center, New York City; and Antonella Surbone, MD, PhD, FACP, Professor in the Division of Hematology and Medical Oncology at New York University School of Medicine, according to their recent editorial (J Clin Oncol 2017; https://doi.org/10.1200/JCO.2017.74.3450).
"Although significant success is certainly true for advocacy, it may be best to limit any celebration regarding the success of the medical management and care delivery aspects of survivorship care," the three noted. "Furthermore, the unique individual and sociocultural factors that play a major role in the delivery and acceptance of survivorship care are yet to be fully addressed."
They argue that better "categorization" of cancer survivors would help tailor care to better meet the very different needs for more patients on the spectrum of their post-cancer journeys.
1. What area of care for cancer survivors still needs attention and improvement?
Tralongo, McCabe & Surbone: "We wanted to make the point that survivorship care shouldn't have a one-size-fits-all approach. Rather, we now understand that care can and should be tailored based on treatment exposures. And, even though many survivors do very well, we should focus on assuring the highest quality of care for all individuals after treatment ends.
"Much progress has been made in terms of care and medical care in survivors. However, much still needs to be done to create the best survivorship care model. Many of these patients suffer from the late effects of active treatments—surgery, chemotherapy, radiotherapy—that are not only intended as physical disturbances, but also as psychological discomfort.
"Individual and sociocultural factors that play an important role in accepting survivorship care need to be taken into account. As the number of cancer survivors continues to increase, it becomes more and more important to educate health providers about the care standards that have been developed so to assure that survivors receive quality care internationally. Patient categorization is a further step forward."
2. How does patient categorization work when it comes to cancer survivorship care?
Surbone: "The categorization of cancer survivors that we have proposed in the present and past JCO articles requires a paradigm shift in the culture of cancer survivorship care, whereby we abandon a common, general approach to all cancer survivors in favor of the application of our epidemiologic knowledge and the developing risk assessment tools to tailor follow-up and recommendations to each individual cancer survivor. Cancer and survivorship care should both move to personalized precision approaches, as it is done in other chronic diseases.
"Personalizing follow-up will improve the medical and psychosocial care for each individual survivor and will help reduce the stigma of disease that still persists in many cultures."
Tralongo & McCabe: "The key thing to understand is that cancer survivorship is a formal period of care with a developing set of care guidelines that are specific to categories of patients, allowing for tailored, patient-centered care. Indeed, knowledge of these topics will help improve the care patterns, enabling better identification of individual disorders and individual risk."
3. What's the next step to developing better survivorship care models?
McCabe: "Research is still needed to evaluate the effectiveness of various models of survivorship care that have been developed, but not evaluated. Related research is needed to understand the most relevant models of care for underserved survivor populations. In addition, health services research is needed to evaluate the degree of dissemination of interventions developed for the management and prevention for long-term and late effects of treatment."
Tralongo: "At the same time, it is important to start rehabilitation pathways that should be considered as multidimensional/comprehensive rehabilitation, focused on improving or regaining both physical and psychosocial abilities, as needed from diagnosis onward."
Tralongo, McCabe & Surbone: "At the national level, ongoing efforts are needed by key organizations such as ASCO, American Cancer Society, National Comprehensive Cancer Network, and Institute of Medicine to continue their leadership in developing guidelines for clinical care of survivors.
"At the local level, a commitment is needed by the oncology community and primary care community to focus on the needs of survivors with attention to implementation of what we know along with researchers across the spectrum of medical, psychosocial, health services, and epidemiologic specialties, as well as to evaluate genetic mutations and environmental exposure."