Cancer Survivorship

June is national cancer survivorship month, and it is a celebration of the advances that we have achieved over the past century against this group of diseases collectively known as cancer. More people are living with a cancer diagnosis each year, and they number in the tens of millions in the United States and worldwide. While most of our cancer treatment focuses on what happens before and during the therapy process, those who have completed cancer therapies have to deal with what happens after. The phase of cancer care management that is often lacking.

One issue with regard to cancer survivorship is coordination of care between oncologists and primary care physicians. Given the rise in number of cancer survivors, it is increasingly beyond the capacity of cancer specialist to care for them. Therefore after several years of remission, care of cancer survivors are often being relinquished back to their primary care doctors. However, primary care providers often do not possess a complete understanding of their patients’ cancer treatment or the consequences and long term monitoring needs that cancer therapies entail.

One mandate from the Institute of Medicine is for improvement of the coordination of care between cancer specialists and primary care providers. A key recommendation is for the creation of a “survivorship care plan” (SCP). SCPs include a summary of the cancer treatments one received along with follow-up care plans that would facilitate the transition of care and which will guide management and self-care for cancer survivors. SCPs should be disseminated to both patients and their primary care physicians.

Other frequent issues that cancer survivors have to contend with is that of secondary cancers. Both chemotherapy and radiation therapy can affect normal tissues by causing DNA mismatch and transcription abnormalities in cellular replication. While the majority of these abnormalities can be detected and eliminated by immune surveillance, a small number of them can lead to mutations that ultimately develop secondary cancers. Therefore, cancer survivors need to work with their physicians to undergo routine cancer screening tests as recommended.

A much less recognized long-term problem is that of metabolic syndrome. Metabolic syndrome is a set of factors that increase risks of cardiovascular diseases. Studies have shown that patients who have undergone chemotherapy have at least doubling of metabolic syndrome. Individuals who already have medical problems (diabetes, obesity) or who have a family history of heart disease are probably at even higher risks. It is therefore important to emphasize lifestyle modifications including dieting and exercise to help reduce development of cardiovascular problems as a part of the survivorship care plan.

As cancer treatments improve and we have increasing numbers of patients who survive their disease, patients along with their physicians should remain mindful that the treatments themselves may have long term consequences that should not be lightly forgotten. Cancer care should continue beyond mere surveillance for cancer recurrence, and only with judicious management of the patient’s mental and physical well being will we truly be able to help patients past the shadow cast by a cancer diagnosis.