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Addressing the Needs of Cancer Survivors: An Emerging Global Challenge

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Guest student blog by Matthew J. To, BMSc candidate,  Schulich School of Medicine and Dentistry, The University of Western Ontario (email mto3@uwo.ca)

This past summer, I worked as a research student at a new cancer survivorship research centre, one of the first of its kind in Canada [1]. It was through working at the centre that I came to realize the enormous challenge that the global community is faced with in addressing the needs of cancer survivors. In this piece, I hope to share some of the things I learned through my work experience.

Despite the huge amount of cancer research that is being conducted worldwide, it is clear that this disease or rather, this set of diseases, will be sticking around for a while [2]. With the ever increasing number of individuals who are diagnosed, the emerging field of cancer survivorship plays an important role in highlighting and addressing the needs of patients from the time of diagnosis to after treatment. There are over twenty-eight million cancer survivors worldwide [3]. Traditionally, a cancer survivor is someone who has been diagnosed with cancer, but this definition has been updated to include family members, friends, and caregivers of the affected individual [4]. Cancer survivorship as a field deals with a whole range of issues including but not limited to cancer-related physical and psychological issues, lifestyle after treatment such as the return-to-work transition as well as follow-up care and prevention of secondary malignancies [4].

In the past, it was not particularly clear whose responsibility it was to address issues like cancer-related fatigue after treatment. If the patient had already received the proper treatment, were they expected to approach their family physician or their oncologist? For more sensitive topics like psychosexual issues prevalent in genitourinary cancers, patients and physicians alike may have been uncomfortable in addressing the topic. However, this appears to be changing. For example, family physicians want to be more involved in managing care for patients affected by cancer and oncologists have been involved in the delivery of follow-up models which include screening for recurrence and promoting healthy lifestyles [5, 6]. Also, many non-profit organizations such as the National Coalition for Cancer Survivorship have worked tirelessly to raise awareness about the issues faced by cancer survivors and advocate for high-quality care [7].

Delivering quality survivorship care is often complicated by the fact that each type of cancer has its own unique set of subtleties that need to be addressed. For example, testicular cancer primarily affects young men between the ages of 15 to 35 and high cure rates of the disease have led to a huge increase in the number testicular cancer survivors [8, 9]. Some issues that these survivors are faced with are infertility and sexual dysfunction [10]. Managing survivorship care for this younger population of survivors would be markedly different from a disease like lung cancer which generally affects an older population. Moreover, factors such as employment status, food availability, and emphasis on spirituality differ between populations within each country and between countries. This means that countries will have to develop survivorship strategies that uniquely address the needs of their respective populations [6]. Furthermore, the aging of the oncology workforce and the increasing number of survivors worldwide presents an additional challenge [11].

Undoubtedly, individuals diagnosed with cancer will need much more than the latest surgical intervention to live healthy and happy lives. Cancer survivorship as a field seeks to address the needs of survivors with a holistic and increasingly community-engaged approach. As the global population of survivors steadily increases, more partnerships between health care professionals, research groups, and community organizations are needed to bring cancer survivorship forward in tackling the unique challenges faced by those impacted by cancer.

References

1. ELLICSR (2010) Available: http://ellicsr.ca. Accessed: 24 February 2011.

2. Downar J (2010) Cancer: it’s time to change the sign. CMAJ 182: 1588.

3. American Cancer Society (2008) Lance Armstrong Announces Global Cancer Summit. Available: http://www.cancer.org. Accessed 24 February 2011.

4. National Cancer Institute (2006) About Cancer Survivorship Research: Survivorship Definitions. Available: http://cancercontrol.cancer.gov/ocs/definitions.html. Accessed: 21 February 2011.

5. Grunfeld E (2005) Cancer survivorship: a challenge for primary care physicians. British Journal of General Practice 55: 741-742.

6. Robinson E (2010) Expert Editorial: The Global Puzzle of Survivorship: Assessing Current Standards, Gaps, Best Practices. Available: http://www.asco.org/ASCOv2/Meetings/Gastrointestinal+Cancers+Symposium/2011+Gastrointestinal+Cancers+Symposium+Daily+News/Features/Expert+Editorial:+The+Global+Puzzle+of+Survivorship:+Assessing+Current+Standards,+Gaps,+Best+Practices. Accessed: 24 February 2011.

7. National Coalition for Cancer Survivorship (2010). Available: http://www.canceradvocacy.org. Accessed: 21 February 2011.

8. Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ (2008) Medical Treatment of Advanced Testicular Cancer. JAMA 299: 672-684.

9. Gospodarowicz M (2008) Testicular cancer patients: considerations in long-term follow-up. Hematol Oncol Clin North Am 22: 245-255.

10. Arai Y, Kawakita M, Okada Y, Yoshida O (1997) Sexuality and fertility in long-term survivors of testicular cancer. Journal of Clinical Oncology 15: 1444-1448.

11. Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M (2007). Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract 3:79-86.

Competing interests: Matthew To states that he worked as a paid research student at ELLICSR (Electronic Living Laboratory for Interdisciplinary Cancer Survivorship Research).

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