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 It's been more than a decade since the Institute of Medicine (IOM)
released its seminal 2006 report on adult cancer survivors. The
report galvanized the cancer care community, calling for a shift in
thinking to focus not just on treating tumors but also on minimizing
lifelong medical problems that can be caused by malignancies or by
surgery, medication, and radiation.
Although there has been progress, many recommendations from the 2006
report have not been fully implemented, researchers note in the
Journal of the National Cancer Institute.
"One of the greatest `advances' has been in a greater recognition of
the continued challenges that cancer survivors face after treatment,
whether it be organ toxicity or premature aging from chemotherapy,
residual effects from surgery, the psychological stress that comes
with not knowing if the cancer will return, and the financial
toxicity of therapy, which can sometimes continue on a long-term
basis since some treatments continue indefinitely," said lead author
Dr. Ron Kline of the Center for Medicare & Medicaid Innovation in
Baltimore.
"Recognition of these gaps is spurring leaders in the field to
develop and test new models of survivorship care and to critically
ask what `quality' survivorship care looks like," Kline said by
email.
Since the IOM report came out, health care providers have done
better at helping patients and families understand that survivorship
is a distinct phase of cancer care, Kline's team reports.
For example, the IOM recommended that patients get "survivorship
care plans" to help them navigate the ongoing screening and therapy
after they complete cancer treatment. But it's unclear how widely
used these plans are, or whether or how they improve outcomes.
Part of the problem is that there aren't clear quality benchmarks
for measuring or improving survivorship care. Most quality measures
focus on treating tumors, not on helping survivors navigate life
afterward, the new report notes.
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Education for providers on survivorship care recommended by the IOM
hasn't been widely used by clinicians, even when professional and
volunteer organizations have developed training programs, the new
report says.
One area of progress is insurance. The Affordable Care Act, also
known as Obamacare, requires health plans to sell coverage even to
people with pre-existing conditions and charge fees similar to what
people without a cancer history might pay. The permanence of many
provisions of Obamacare is uncertain, researchers note in the new
report.
Lasting financial problems can also linger for years, with missed
work and disabilities that limit job prospects and with medical
bills from ongoing care, said Dr. Ryan Nipp of the Massachusetts
General Hospital Cancer Center in Boston.
"Survivors of cancer often require close monitoring and frequent
interactions with the health care system as a result of their
cancer, which can lead to high out-of-pocket costs and continued
time away from work," Nipp said by email. "This financial burden can
affect patients' quality of life and may influence their decisions
surrounding their survivorship care."
Another challenge with newer treatments is that doctors haven't had
enough experience with them yet to fully understand patients'
long-term prognosis, Nipp said.
"Some of the biggest challenges include issues related to the
definition of cancer survivorship and the evolving landscape of
cancer therapies, which can often complicate oncologists' ability to
accurately prognosticate for our patients," Nipp added.
SOURCE: http://bit.ly/2EI6EaY Journal of the National Cancer
Institute, online November 29, 2018.
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