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Assuring quality of care for cancer survivors: The survivorship care plan

Author
Carrie Tompkins Stricker, PhD, RN
Section Editor
Patricia A Ganz, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

The term "cancer survivor" has been used variably in the literature; most commonly, a cancer survivor refers to any person who has been diagnosed with cancer. Therefore, survivorship begins at the time of diagnosis and includes the periods of initial treatment with intent to cure, cancer-free survival, chronic or intermittent disease, and palliative care [1]. For the purposes of this topic, we will focus on the post-treatment period of survivorship.

There are now over 14 million cancer survivors in the United States [2] and close to 30 million survivors worldwide [3]. Following cancer treatment, the roles and responsibilities for survivorship care should be well delineated for both patients and their providers, particularly during transitions. The follow-up of cancer survivors can be shared among the primary care provider (PCP), medical oncologist, and other cancer specialists, and is often transitioned to the PCP after the period of highest risk for disease recurrence (often five years, but sometimes longer). For survivors, the transition from oncology to primary care settings should be guided by the survivorship care plan (SCP), which is developed by the oncology team at the completion of treatment and is meant to be shared with the patient and his or her providers, including the PCP.

This topic will address the evidence supporting SCPs in cancer survivors, implementation, and barriers to implementation. An overview of cancer survivorship care for primary care and oncology providers is provided separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)

OVERVIEW OF SURVIVORSHIP EPIDEMIOLOGY

Following completion of initial treatment, more than 60 percent of adults diagnosed with cancer are expected to become long-term cancer survivors, living five years or more following their cancer diagnosis [4]. At present, it is estimated that there are more than 14 million cancer survivors living in the United States [4], and close to 30 million globally [3,5]. This number is expected to grow due to improvements in cancer screening [6], increases in life expectancy following definitive cancer treatment [2,6], and the aging of the population [7]. By 2024, it is anticipated that there will be an estimated 19 million cancer survivors in the United States [8]. (See "Overview of cancer survivorship care for primary care and oncology providers", section on 'Epidemiology of cancer survivors'.)

These gains in survival are not without cost, and cancer survivors are at risk for a broad array of potential long-term and late effects of treatment. These include recurrent and new malignancies; increased morbidity and mortality from cardiovascular, skeletal, and other diseases; myriad physical effects such as peripheral neuropathy and lymphedema; and psychosocial distress that may impact work and social relationships [9,10]. Expecting life to be better after cancer treatment may not be a correct assumption for all cancer survivors. One-third of cancer survivors have persisting symptoms that are similar to those they suffered during active treatment; fatigue, pain, depression, and sleep disruption are the most common across different malignancies [11]. An increased number of symptoms and poorer quality of life have been found with younger age, lower socioeconomic status, and a higher number of comorbidities [12]. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment".)

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 09 00:00:00 GMT 2016.
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