An estimated 18.6 million people in the United States — roughly 5.4% of the population — are alive after battling cancer. This number is expected to rise exponentially in the next decade, reaching 26 million by 2040. As we see more and more breakthroughs in cancer treatment, a larger proportion of our population will be made up of cancer survivors, who have distinct needs relating to their physical, emotional, and financial wellbeing. Caring for people with cancer does not stop when the treatment ends.
For National Cancer Survivors Month, experts with the American College of Surgeons (ACS) Commission on Cancer (CoC) are highlighting the need for patients recently diagnosed with cancer and cancer survivors to receive optimal care that supports them through survivorship.
“Treating cancer requires multidisciplinary care from the moment of diagnosis through survivorship,” said Laurie J. Kirstein, MD, FACS, Chair of the CoC and a surgical oncologist at Memorial Sloan Kettering Cancer Center in New York, who specializes in treating breast cancer. “With advances in cancer treatments emerging every year, we’re seeing more and more patients living longer with cancer, so care plans should reflect their well-being throughout their life.”
The CoC is leading efforts to better understand the needs of cancer survivors and has developed standards for hospitals and cancer centers accredited by the CoC and the ACS National Accreditation Program for Breast Centers (NAPBC) to directly support cancer patients through survivorship.
What Is Cancer Survivorship?
Cancer survivorship refers to all the phases of life that begin when a cancer is diagnosed and continues through and after when treatment is finished. Survivorship care may look very different for different people, based on the stage and type of cancer, their health, as well as their personal goals and priorities.
For early-stage tumors with high cure rates that are treated with a single minor procedure, survivorship care may focus less on challenges relating to treatment side effects or risk of the cancer coming back and instead focus more on patients undergoing follow up for new cancers and lifestyle changes that can decrease their risk.
Priorities also change as the cancer population changes and treatments improve. For example, more young women are being diagnosed with cancer while still of reproductive age, which can have different treatment implications compared to post-menopausal women. At the same time, people are surviving much longer with advanced cancer because of innovative treatments, which may also influence the way patients imagine their potential futures and prioritize treatment goals.
“We want patients to live well, not just live long, while undergoing cancer treatment and afterwards,” said Daniel J. Boffa, Vice-Chair of the CoC and division chief of thoracic surgery at the Yale School of Medicine. “Treatment priorities can look different for different patients. All patients deserve to have optimized care, with plans to match each as individual people, their induvial cancers, and their personal goals.”
What Types of Challenges Do Cancer Survivors Face?
When diagnosed with cancer, patients may face many challenges for years, even after their cancer treatment ends. These challenges broadly fall into two domains: physical and emotional health
- Physical health challenges: Cancer treatments, while mitigating the disease, can be highly toxic to the body, affecting heart health, muscle and bone health, sexual health, and fertility, among other areas. Appropriate counseling and referrals to specialists can help patients understand their treatment options. For example, a patient who wishes to preserve their fertility may choose to undergo fertility preservation treatments with a reproductive endocrinologist before starting cancer treatment; other times, physical therapy may be prescribed to help maintain strength and mitigate some of the toxic side effects of chemotherapy and other cancer treatments.
- Emotional health challenges: Any diagnosis of cancer takes a significant emotional toll on both patients as well as their loved ones and caregivers. Treatments can drain finances, stress relationships, and trigger emotional health issues such as anxiety and depression.
“Even long after treatment ends, patients may also face the fear of recurrence,” Dr. Kirstein said. “Many breast cancer patients who have a lumpectomy or a mastectomy on one side may continue to be monitored with mammograms or breast MRIs frequently, which can trigger stress and worries about the cancer returning or developing in the other breast.”
Referrals to counselors, therapists, and other specialists early on in the cancer diagnosis can support patients with resources and coping mechanisms.
- Social and economic challenges: The challenges faced by cancer survivors can also extend to social and economic difficulties. For example, more than half of patients and survivors report experiencing some level of social isolation. And while many relationships stay strong through a cancer diagnosis, some patients experience divorce or separation.
Finances are often another challenge for patients and survivors, and job security can be negatively impacted by a diagnosis. Further, recent studies show patients with cancer are nearly 5 times more likely to experience bankruptcy, and many patients also experience a negative impact on their credit scores.
What Resources are Available for Cancer Survivors?
Hospitals with cancer programs accredited by ACS have survivorship standards in place that provide centers with a framework to develop and implement programs and referrals that address persistent symptoms and functional issues a patient may be facing, including issues that may be affecting their emotional and social well-being.
“The goal of these standards is to provide a framework to help patients not just survive on the other side of cancer treatment, but to thrive,” Dr. Boffa said.
Resources offered to patients at CoC and NAPBC-affiliated centers may include referrals to local or online exercise programs or to a counselor or social worker to address emotional health challenges, seminars for survivors, and nutritional counseling.
Additionally, CoC-accredited centers have access to a Financial Toxicity and Health Literacy Toolkit which helps connect patients treated at these centers to resources to address financial challenges.
More information about cancer survivorship can be found at the American Cancer Society, which has several public resources about the late and long-term effects of cancer treatment and managing health care.
Resources for Media Members
Drs. Kirstein and Boffa are available for media interviews to discuss cancer survivorship. Please contact pressinquiry@facs.org to schedule an interview.
