This volume presents the MD Anderson experience in providing care and services to
the rapidly growing population of cancer survivors, which is currently
estimated to be 12 million in the United States and more than 25 million
worldwide. As cancer survival rates have increased, it has slowly become
clear that the challenges faced by people with cancer do not end with treatment
but simply change. This book aims to assist community oncologists, physicians,
and their staff, who care for the vast majority of cancer survivors, by
disseminating models of surveillance for disease recurrence, screening for
second primary cancers, education regarding potential late effects of
treatment, and psychosocial counseling. These models have proven valuable
to cancer survivors who receive care at MD Anderson.
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Maria Alma Rodriguez
Part I Clinical Care Delivery
Models of Survivorship Care
Maria Alma Rodriguez and Frances Zandstra
Community Care Integration
Lewis E. Foxhall
Part II Surveillance
Adult Survivorship of Pediatric Cancers
Joann L. Ater
Breast Cancer Survivorship Management
Phuong Khanh Morrow
Colorectal Cancer Survivorship Management
Shahab U. Ahmed and Cathy Eng
Genitourinary Cancer Survivorship Management
Marcia L. Patterson, John W. Davis, Jeri Kim, Karen E. Hoffman, William E. Osai, and Deborah A. Kuban
Gynecologic Cancer Survivorship Management
Diane C. Bodurka, Shannon N. Westin, and Charlotte C. Sun
Head and Neck Cancer Survivorship Management
Katherine A. Hutcheson and Carol M. Lewis
Hematologic Cancer Survivorship Management: Transplantation
Karen Stolar, Amin Alousi, Joyce Neumann, and Richard Champlin
Hematologic Cancer Survivorship Management: Leukemia
Hematologic Cancer Survivorship Management: Lymphoma
Maria Alma Rodriguez, Leslie Ballas, and Kristin Simar
Melanoma Survivorship Management
Genevieve Marie Boland and Jeffrey E. Gershenwald
Thyroid Cancer Survivorship Management
Sherrie L. Flores and Mouhammed Amir Habra
Part III Cancer Prevention and Screening
Maher Karam-Hage and Paul M. Cinciripini
Obesity and Exercise
Sally Scroggs and Clare McKindley
Screening for Second Primary Cancers
Therese B. Bevers
Part IV Long-Term and Late Effects
Michael S. Ewer
Christina A. Meyers
Mimi I. Hu, Camilo Jimenez, Naifa L. Busaidy, and Mouhammed Amir Habra
Carmen P. Escalante and Ellen F. Manzullo
Kenneth V.I. Rolston
Leslie R. Schover
Part V Other Crosscutting Issues
Laurel R. Hyle
Communication Between Patients and Health Care Providers
Daniel E. Epner
Gabriel Lopez, Richard Lee, M. Kay Garcia, Alejandro Chaoul, and Lorenzo Cohen
Progress in cancer research, prevention, diagnosis, and treatment during the four decades since the passage of the National Cancer Act of 1971 has been truly remarkable. These advances have made it possible for increasing numbers of people to survive long after a cancer diagnosis. It is estimated that there are now around 12 million cancer survivors in the United States alone and more than 25 million worldwide (Ltekruse et al. 2010; International Agency for Research on Cancer 2008). Although this is cause for celebration, much remains to be done. We are still losing too many lives to this disease, and progress on certain types of cancer has been frustratingly slow. In addition, it is becoming clear that surviving cancer brings with it a whole new set of challenges for these individuals.
In 2003, the President’s Cancer Panel heard testimony from more than 200 cancer survivors and caregivers, who described the difficulties involved in living beyond cancer treatment. At that time, there was little recognition of the challenges faced by cancer survivors in trying to reestablish productive lives. The report of the President’s Cancer Panel (2004), “Living Beyond Cancer: Finding a New Balance,” attempted to describe the sense of abandonment experienced by people who had completed their treatment but now needed a different type of assistance to restore order to their lives.
It was clear that information regarding treatments received, follow-up plans, and potential late effects of treatment were not available to most patients; needs for psychological support and financial and legal counseling were not being met; and recognition that life after cancer was dramatically different from life before cancer was lacking in the medical community. These findings were reiterated and amplified in an Institute of Medicine report in 2006 entitled, “From Cancer Patient to Cancer Survivor: Lost in Transition” (Committee on Cancer Survivorship 2010). Both reports made it clear that the end of cancer treatment did not signify the end of the needs of and challenges for cancer survivors. These findings indicated that it was time for a shift in focus from curing the disease to caring for the patient through and beyond the disease.
It is very rewarding to see that cancer care is beginning to be viewed as a continuum from prevention to survivorship care, and that cancer survivorship is emerging as an important aspect of the care of cancer patients. This is evident from the creation of the Office of Cancer Survivorship by the National Cancer Institute in 1996 and in the work of the Lance Armstrong Foundation, which in 2005 created the LIVESTRONG Centers of Excellence Survivorship Network, which seeks to offer “information, care, and services to cancer survivors, their family members, and health care providers” (LIVESTRONG 2011). It is also evident from the work presented in this volume, which describes the MD Anderson experience and models for delivering care and services to cancer survivors. As described here, the needs of patients and models of care may differ depending on the age of the patient at the time of treatment, the type of cancer, the treatment received, and the individual circumstances of each person. Nonetheless, there are common elements to address, regardless of these differences, such as the needs for surveillance for disease recurrence, screening for second primary cancers, education regarding potential late effects of treatment, and access to psychosocial counseling. This book provides an excellent guide to addressing these issues and should be of assistance to community oncologists and physicians and their staffs, all of whom must deal with the ever increasing population of cancer survivors. This is extremely important, because the vast majority of cancer patients are treated in the community, not at comprehensive cancer centers, and long-term follow-up of cancer patients is also largely the province of these health care providers. In my view, this book is important because it will help to disseminate models for the care of cancer survivors to the larger medical community outside the academic medical centers and because it represents a major step forward in helping people live productive lives after cancer treatment.
Margaret L. Kripke, PhD
Vivian L. Smith Chair and Professor of Immunology, Emerita
The University of Texas MD Anderson Cancer Center
Member, President’s Cancer Panel
Member, LIVESTRONG Centers of Excellence Network Steering Committee
Committee on Cancer Survivorship. Improving care and quality of life. In: Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition . Washington, DC: The National Academies Press; 2010.
International Agency for Research on Cancer. World cancer report. Boyle P, Levin B, eds. Lyon,France: IARC; 2008. Accessed June 26, 2013.
Defining Survivorship Care: Lessons Learned from the LIVESTRONG Survivorship Center of Excellence Network. LIVESTRONG; 2011. Accessed June 26, 2013.
Ltekruse SF, Kosary CL, Krapcho M, et al. (eds). SEER cancer statistics review, 1975–2007 (based on November 2009 SEER data submission). Bethesda, MD: National Cancer Institute, 2010.
President’s Cancer Panel. Living Beyond Cancer: Finding a New Balance . Bethesda, MD: National Cancer Institute; 2004.