In 2005, the Institute of Medicine released a report with a title that became a wake-up call for many in the field of oncology, From Cancer Patient to Cancer Survivor: Lost in Transition. A committee of 17 experts in the field set out to raise awareness of the consequences of having cancer and cancer treatments, to define a standard of healthcare quality for cancer survivors, and to determine how to implement that quality and to improve the quality of life of cancer survivors.1 In the 8 years since this report, there has been some progress toward these goals but arguably not enough. Many large and small oncology centers and practices have developed survivorship programs, but there are many uncertainties regarding how best to integrate such programs with existing oncology follow-up. Transition of patients or comanagement of patients with other providers, including their primary care physician, remains a challenge in terms of defining the roles of each provider in the overall care of the patient. Oncology practices are starting to develop treatment summaries and surveillance outlines, but they remain a minority. Research in survivorship remains a very small slice of the overall dollars devoted to cancer funding.
Beth Faiman’s article raises a very important point with her discussion of who is a survivor. Without a definition, it is hard to focus the energies needed to improve the “lost in transition.” Some define survivor broadly, beginning with the day the patient is diagnosed. Others define it as the period when treatment ceases and there is no evidence of disease. And there are gray areas in between. Regardless of the definition, caring for the cancer survivor is complex and requires a team approach. Within that team, the roles of each provider need to be defined to achieve the health maintenance that Ms Faiman outlines in her perspective.
Steve Stricker’s article focuses on the need to follow cancer survivors for late effects of therapy. I would add to this argument that this is where research is so far behind in the continuum of our understanding of cancer. The article mentions the cardiovascular effects of anthracycline exposure. This toxicity has been known for many years. While there are data on the timing of such effects and the cumulative dose of drug that substantially impacts the risk, little is known about which patients get such toxicity or how to avoid it. Such lack of research is common for most late side effects of cancer therapy. We have reasonably good data on the percentage of patients impacted and when the late effect is seen, but beyond that there are huge research needs in the field.
Ten years ago, a series like Conquering the Cancer Care Continuum may not have included survivorship as a topic. Thus, having the perspectives by Beth Faiman and Steve Stricker in this series is a clear reflection that progress has started. However, we all still remain a bit lost on the issue and should work together to improve our understanding and our care of the increasing proportion of our population that are cancer survivors.
- Institute of Medicine. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press; 2005.