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Post Cancer Survivorship Measures
Ernest H. Rosenbaum, MD, Patricia Fobair, LMSW, MPh, and David Spiegel, MD

Introduction
Recommended Roadmap for Survivors Introduction
Post Therapy Screening Guidelines


Introduction

Survivors of cancer graduate to a new life, but may face many consequences both psychological and physical related to their therapy. The challenges they face can best be overcome with a team approach, including their medical team, family, friends, community resources, and, most importantly, themselves.

The medical community needs to provide information which include:
1. Knowledge about short and long-term potential side effects and possible recurrence or a new cancer.
2. A standardized follow up program highlighting potential future problems and necessary follow up medical observational programs.
3. Knowledge of lifestyle changes that can reduce the risk/severity of side effects and co-morbidities.
4. Psychosocial and group therapy for support for anxiety, fear, isolation and depression problems
5. A list of community resources to aid in obtaining benefits, insurance, employment protection, and life support needs
6. Ongoing communication of new advances in medicine and current research which could be of aid in reducing the after-effects (sequellae) of both cancer and cancer therapy.

Armed with this knowledge, survivors can be proactive, initiating necessary changes to promote better health and longevity. With greater awareness of possible late side effects, they can anticipate potential problems and take earlier action to prevent adverse outcomes. Awareness of risks will also motivate survivor participation in surveillance programs. The goal is to promote wellness through health promotion and disease prevention.

New standards of care are being developed over time, and clinical guidelines are being provided to enhance the quality of care. One of the challenges for the medical community is that the increasing number of survivors presents difficulties for providing care in busy oncological practices and ambulatory clinic practices. Informed survivors who adopt recommended lifestyle changes are less likely to require as much physician attention as hopefully they will live healthier.

Recommended Roadmap for Survivors Introduction

By providing patients with a summary of their medical history or a comprehensive letter with follow-up recommendations, oncologists make it possible for survivors to truly understand the lifelong scope of their condition and become partners in their medical care. Although many survivors wish to forget their cancer experience at the end of their therapy, many others need the reassurance of having a plan and knowing how to recognize what may be side effects of their disease or its treatment.

There is no specific follow-up schedule, as each cancer and patient are different and will require different follow-up program guidelines, in part depending on the type of cancer, its risks, and its aggressiveness, but there are generalized guidelines.

The following section presents an outline of suggestive recommended elements for a survivor's follow-up care plan.

An example of a cancer survivor follow-up plan
1. Patient name: Address: Telephone numbers: 
   
2. Medical record number: 
 
3. Hospitals where treated:
   
4. Diagnosis:Type of cancer Pathology and grade
   
5. Doctors involved in care:
Names:  Addresses:  Telephone numbers: 
   
6. Brief History:
Clinical evaluation:  X-ray:  Lab tests: 
   
7. Treatment:
Surgery report:
 
Radiation therapy report: Type:  
  
Dose:  X-ray field:  Where performed: 
   
Chemotherapy and/or immunotherapy report: Protocol:
  
Drugs:  Dose:  Frequency: 
   
8. Potential short- and long-term consequences of therapy (such as delayed cardiac toxicity or delayed physical impairment) and side effects:
 
9. Suggested post-treatment plan for potential second malignancies or recurrence
 
10. Follow-up recommendations for the next 10 to 20+ years: Intervals for follow-up doctor visits:  Tests needed (a plan): 
   
11. Resources for supportive care for: group or family support, occupational therapy/physical therapy, home care, psychosocial support for survivors, and physical care (pain, nutrition, fatigue, or sexual dysfunction).
 
12. Information on insurance, employment protection and community resources.
 
13. Obtain medical reports from MD, x-ray and lab reports of vital information.
 

Post Therapy Screening Guidelines

Consensus guideline templates are being developed to promote wellness and quality of life from the time of diagnosis through the current standard of 5 years post treatment surveillance and into long-term 10-20 plus year follow-up survivorship. These guidelines include monitoring and management.

Follow up care is essential and in reality will most likely be delivered by primary care physicians. There is a need for experience in long-term follow up for chronic conditions, even after a period of wellness, which may well be over 10-20 plus years and for a lifetime.



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