CHICAGO–In a session entitled “Depression, Anxiety, Neuropathy, and Fatigue: An Update on the 2014 ASCO Survivorship Guidelines and How to Incorporate Them into Practice” presented at the 2015 American Society of Clinical Oncology annual meeting, session chair Ann H. Partridge MD, MPH, discussed the challenges that oncologists face in standardizing survivorship guidelines for their adult patients.
As of 2012 in the United States there were 14 million cancer survivors, a number that is expected to grow to 18 million by 2022.
In her presentation Dr. Partridge summarized her adaptation of the Institute of Medicine’s definition of survivorship care as:
- surveillance, screening, and preventing cancer recurrence or development of new cancers (which includes fostering adherence to clinical guidelines and risk-reducing treatments)
- identifying and managing late and long-term medical, psychological, and social effects
- encouraging patients to demonstrate healthy behaviors
- coordinating care throughout the health care spectrum to ensure patients are sufficiently provided for
At this time, Dr. Partridge explained, oncologists are aware that planning is required in order to deliver sufficient survivorship care to their patients.
Planning survivorship care requires a variety of effforts including an understanding of the issues, the creation of evidence and consensus within the community, the development of systems and tools that aid in the adherence to standards, resources, and, perhaps most difficult to establish, a willingness to change both at a personal and institutional level.
The understanding that survivorship is a necessary component of cancer care is not a new concept, but it is a phase of cancer care that is often neglected.
The challenges that oncologists face in creating and implementing standards of care for cancer survivors were summed up by Dr. Partridge into two parts:
- oncology care providers still have substantial work to do in curing the diseases they treat and are often focused on that treatment
- cancer is a complex disease that has a wide range of therapeutic interventions and associated risks
Another challenge outlined by Dr. Partridge is the lack of research, particularly prospective studies and randomized controlled trials, on the topic of survivorship.
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“Even when there are data, and even when evidence exists, many do not follow those data,” Dr. Partridge said, pointing to research from Keating and colleagues that demonstrated a published guideline having limited effect on practice.
The key factor, perhaps, in moving forward and streamlining establishing guidelines into practice is acknowledging the fact that not all patients need the same services. Pointing to data from Boyajian and colleagues who surveyed cancer survivors on the services they needed and the times at which they would want them. The results showed disparity among patients when it came to what they felt they needed and when within their treatment they wanted those services.
“We don’t want to be pushing services or squandering resources on patients where it’s not necessary,” Dr. Partridge said.
With this in mind, it is necessary to target survivorship care so that the appropriate level of support is given to each patient, ideally giving each patient a baseline level of service and offering a variety of options that go into higher levels of supportive care.
Dr. Partridge referred to a schema from the UK National Cancer Survivorship Initiative that indicated 70% of patients did not need intensive survivorship care after their basic survivorship needs were met.
Survivorship care, in many ways, is an extension of quality care, Dr. Partridge explained. And while quality care focuses on ensuring that patients are receiving the right amount a care, survivorship care shares the same goal.
In her final statements, Dr. Partridge also stressed the importance of evidence. “I would argue strongly that whatever we build…we need to do rigorous intervention and program evaluation to continue to build the evidence base and demonstrate the value of survivorship programs.”