Many people consider “cancer survivorship” as a patient’s life after cancer is cured. However, the Centers for Disease Control and Prevention (CDC) define a cancer survivor as “a person who has been diagnosed with cancer, from the time of diagnosis until the end of life.” This means living with cancer, surviving it and all its complications.
As a pharmacist, it is important to understand the difficulties a cancer survivor may face, the importance of their continued care and what can be done to improve their care and quality of life.
Positive Growth in Survivorship
With early screenings, better detection methods, improved treatment regimens and new drug therapies, patients are living longer after a cancer diagnosis than ever before.
Almost 14 million people in the U.S. are living with a diagnosis of cancer. About 66% of patients diagnosed with cancer are expected to live at least five years after their diagnosis.
Despite these improvements, most patients will struggle with the physical, emotional and financial burden of their cancer and treatment regardless if they are fortunate enough to achieve remission. Cancer survivors are more likely than people who have never received a cancer diagnosis to develop chronic health conditions.
More than 25% of adult survivors report having a serious, life‐threatening or debilitating condition and 66% have at least one chronic condition. We know many of the adverse effects that can occur to patients during treatment, but we are still learning about the late effects (develop months to years after completion of treatment) and long‐term effects (develop during treatment and persist for at least 5 years after treatment).
The fragile and developing systems of pediatric patients make them particularly at risk for complications to cancer treatment by off‐target effects of newer precision medication therapy as well as cytotoxic effects of traditional chemotherapy and radiation.
Adult survivors of childhood cancer are more likely to develop cardiac diseases, struggle with infertility and develop endocrine disorders. These individuals most commonly report fatigue, lack of stamina, musculoskeletal problems, decreased participation in activities and sexual dysfunction to a greater degree than patients with no cancer history in the same age group.
Studies also reflect that a history of a cancer may actually be a distraction to standard prevention and treatment of other common health conditions which may contribute to this higher risk.
The National Cancer Institute is working with the CDC to gather more information by creating a surveillance research program. The Surveillance, Epidemiology and End Results (SEER) program collects data on patient demographics, primary tumor site and morphology, stage at diagnosis and first course of treatment. This research will help guide us toward the best treatments available for patients now and later in life and help develop strategies for long term care of cancer survivors.
Specialized Care for Cancer Survivors
The team of nurses, pharmacists and clinical support in Accredo’s Oncology Therapeutic Resource Center® (TRC) encourage patients to continue their treatment as prescribed. For example, our Gap in Care program helps pharmacists identify patients that may not be following their prescribed treatment and gives us the opportunity to work with patients to address concerns about side effects and what to expect during treatment.
Oncology nurses make follow up calls to check in on patients at designated times after the start of treatment to provide support, encouragement and get them connected with services they might benefit from such as copay assistance or a social worker. Accredo also provides nutrition support for those struggling to maintain weight or dietary restrictions through the use of an online resource called TherapEase Cuisine and the ability to consult with a Clinical Dietician.
As a specialist pharmacist, I also encourage patients to become more active participants in their care by working with their providers to create a Cancer Survivorship Care Plan. The American Cancer Society is one source for valuable tools that help patients and physicians create a care plan by keeping track of information about their medical history, diagnosis, cancer treatment and follow‐up care as well as the need for future exams, cancer tests, potential long‐term and late effects of the treatments received, and recommendations for improving a patient’s health. With a follow‐up care plan and better resources for late and long‐term effects patients will continue to see improvements in their quality of life as cancer survivors.
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