Strategies for caring for the well cancer survivor

The following discussion summarizes evidence and recommendations for each element of the IOM recommendations for survivor care.

Implementing the 4 elements of cancer survivor care

1. Coordinate care through a unified survivorship care plan

The IOM has noted that the needs of cancer survivors are rarely met²; communication between oncology and primary care is often deficient during transition of care. The IOM has recommended that oncologists provide a survivorship care plan that details the cancer (ie, tumor characteristics), the type of treatment (ie, enrollment in a clinical trial; medical, surgical, or radiation), support services, and follow-up recommendations for the primary care provider. (Examples of elements of a survivorship care plan can be found at www.mskcc.org/hcp-education-training/survivorship/survivorship-care-plan⁶ and http://sma.org/southern-medical-journal/article/cancer-survivors-history-physical/⁷).

Regrettably, survivorship care plans have been rarely and poorly employed. Studies show that fewer than one-half of oncologists provide a plan, and that when they do, the plan often lacks recommended information.^8,9 Survivorship care plans may soon become common practice, however; the Commission on Cancer of the American College of Surgeons has required their use in all certified cancer centers since 2015.¹⁰

2. Provide surveillance of existing cancer

Cancer follow-up is challenging after the initial treatment phase. Although there are many conflicting guidelines for surveillance after cancer, guidelines of the National Comprehensive Cancer Network (NCCN) (summarized in TABLE 2¹¹ for the 10 most common cancers in survivors) are the ones generally accepted.^12,13

Although individual surveillance recommendations are based on limited evidence, studies confirm the importance of surveillance. A systematic review showed that surveillance mammography after breast cancer reduces breast cancer mortality by 36%.¹⁴ A study showed that bladder cancer recurrence diagnosed by surveillance instead of by symptoms led to a 35% increase in 5-year survival.¹⁵

Continue to: Yet adherence to cancer surveillance...