What is Cancer Survivorship Care?

Survivorship in Australia is a newly emerging area that refers to the stage at which patients have completed initial cancer treatment. Such patients can sometimes face a range of ongoing issues even after completing cancer treatment.  This area focuses on the health and life of a person with cancer following treatment and until the end of life. Survivorship includes the psychosocial, physical, and financial aspects of cancer, beyond the diagnosis and treatment phases. Survivorship includes issues related to the ability to access health care and follow-up treatment, the late effects of treatment, second cancers, and quality of life. Family members, friends, and caregivers are all considered part of the survivorship experience. The services and interventions required to support survivorship can vary, and care is an evolving process and requires further coordination.

Cancer survivorship is increasingly recognised as an important element of ongoing care for patients following diagnosis and treatment. As a patient group, cancer survivors have unique health needs due to the consequences of their diagnosis and treatment. These include dealing with the late-effects of chemotherapy and radiotherapy, such as specific cardiac issues, an increased risk of secondary cancers, persistent fatigue, chronic pain, lymphoedema, and infertility. Ongoing anxiety, depression and fear of recurrence may also be experienced. Specific cancer treatments may be associated with physical and psychosocial effects requiring multidisciplinary input in their management.

Australia has enjoyed marked improvements in cancer survival due to early detection and improved treatments of cancer. The five-year survival rose from 47% to 66% between the periods of 1982–87 and 2006–10, with survival rates now over 90% for several cancers. The median age of diagnosis of new cancer is 67 years of age. With an ageing population, there is a growing number of people requiring long term follow-up and management of the consequences of a cancer diagnosis and treatment. Furthermore, as there is an increase in the number of older people, then the prevalence of cancer survivors will increase, with this demographic also having age-related comorbidities and supportive care needs. This increasing number of cancer survivors places a greater burden on hospital oncology clinics and adds to the growing demand for more cancer services to be delivered in primary care (Role Redesign Shared Care, 2010).

The following factors have been identified as fundamental aspects of the survivor’s experience:

• Experiencing either positive or negative change
• Trying to stay healthy after treatment
• Handling practical issues such as work, study, finances, etc.
• Ongoing interaction with the health care system, e.g. for follow-up care or rehabilitation
• Coping with the fear of cancer returning
• Challenges in relation to resuming ‘normality’
• Handling the late effects and long-term effects of cancer treatment

A shared care model of survivorship care involves primary healthcare professionals working together with oncologists to result in effective communication and streamlined transition between services. Facilitation of this requires clear guidance for patients and primary care professionals about treatment and follow-up plans, as well as management of treatment adverse effects, and mechanisms for rapid referral and consultation to specialist advice if required. As treatments and in turn survival rates improve, there is emerging a further need to investigate models of care for these patients.