Thanks to significant advances in cancer treatment and
improvements in early detection, the number of cancer
survivors in the U.S. is growing rapidly. There are over 66,000
cancer survivors in Idaho. Today, a diagnosis of cancer is
no longer a death sentence. Patients are living longer with
the disease and are frequently disease free. Cancer survivors
are now dealing with cancer as a chronic illness or with the
chronic side effects of treatment. The growing number of
cancer survivors has created a shift in modern cancer care
that has an increased focus on quality of life for survivors both
during and after treatment. This includes a focus on physical
health as well as mental health throughout the continuum of
care. Oncologists are encouraged to engage their patients in
shared decision making as it relates to issues of survivorship
and long term disease management or palliation.
The National Comprehensive Cancer Network (NCCN)
published clinical best practice guidelines for survivorship
in 2013. In 2014 the American Society for Clinical Oncology
(ASCO) followed suit. Both organizations have also published
guidelines for palliative care and symptom management that
are readily used in cancer care today. The guidelines highlight
the important interface between physical health and mental
health with special attention to not only disease surveillance
and pain management but also assessment and referral for
anxiety, depression, sexual function, nutrition and physical
activity. A growing body of research supports the inclusion of
these issues as part of the quality of life discussion with patients
both during and after treatment for cancer.
Survivorship is
the process of
living
with,
through
or
beyond
cancer.
The Institute of Medicine recommends that every patient
receive a survivorship care plan. The Commission on Cancer
requires all accredited cancer centers to offer these care plans
to patients upon completion of cancer treatment. These care
plans must be comprehensive in nature and meet all of the
minimum requirements set forth by ASCO.
In addition to the new guidelines and recommendations for
survivorship care, there is an increasing effort to improve
palliative care programs and access to hospice services for
cancer patients with high symptom burden and/or limited life
expectancy. The published clinical guidelines for palliative
care and symptom management should guide this care. Efforts
to improve the quality of life of cancer patients should be
accompanied by discussions about advanced care planning
and include the implementation of an advanced directive for
every patient. These discussions are often difficult to conduct
and require that clinicians and staff be trained and comfortable
with the subject. Staff should be able to answer questions
and direct patients to reputable community resources and
organizations.
With the growing number of cancer survivors in Idaho,
healthcare providers, community organizations, researchers,
health plan administrators and advocates must be prepared
to meet the unique and often challenging needs of this
population. With the landscape of healthcare requirements,
guidelines and recommendations ever changing, it is
important that the CCAI offer an opportunity for healthcare
partners to collaborate and receive the latest education on
best practices. There are many different models for providing
survivorship and palliative care to improve the quality of life
of cancer survivors in Idaho and through collaboration and
education this goal can be achieved.