Cancer patients who have completed treatment would be better served if oncology treatment centers were equipped to offer them comprehensive, pro-active follow-up care, according to experts who presented at the survivorship forum ‘Developing a Cancer Survivorship Program’ being held in Atlanta (Wednesday April 28, 2010).
“Earlier detection and better treatment methods mean that two of every three adult cancer survivors are living five years after treatment,” said Steven Castle, administrator of CJW Medical Center’s Thomas Johns Cancer Hospital (TJCH) in Richmond, Virginia. “The survivor population in the United States is nearing 14 million and growing at nearly 10 percent per year. At TJCH, there are about 1,800 survivors finishing treatment each year.”
The lack of follow-up care can result in sub-optimal long term outcomes, says Matthew P. Mumber, M.D., radiation oncologist with the Harbin Clinic in Rome, GA. According to Dr. Mumber, very specific forms of follow-up care have a better chance of positively impacting a survivor’s quality of life after treatment.
Dr. Mumber cited studies showing that behavioral and lifestyle changes can have a significant impact on the progression of prostate and colon cancer, and advocated for “transformational” support that helps patients navigate through the physical, mental, emotional, and spiritual challenges involved in replacing old habits and patterns with newer, healthier ones. One cited study showed that diet and lifestyle changes were directly correlated with prostate cancer patients’ ability to prevent the progression of their disease.
Another study found a significant increase in colon cancer recurrences and mortality among survivors with the highest intake of a high-fat western-patterned diet, with heavy consumption of red meat, sugary desserts, and refined grains. However, Dr. Mumber pointed out that, in the current model for cancer treatment, there is little support for making the lifestyle changes that could positively impact survival.
According to Castle, cancer survivors receive highest quality care during the active phase of their treatment, but can be lost in transition to the more passive follow up phase of survivorship. “Sometimes patients may feel abandoned or lost after their last radiation or chemotherapy treatment or their last appointment with the surgeon,” he said.
“Patients in the acute phase of being treated for cancer are helped through the use of technology, tests, and procedures. This is a ‘top down’ sort of treatment, with an expert–the doctor–using his or her clinical judgment to make important decisions and guide the process. During the survivorship phase, a more patient-centric approach that supports survivors’ efforts to make important lifestyle changes is more likely to have an impact,” Dr. Mumber said.
“In our program, physicians understand that they remain in control,” says Tricia Cox, nurse practitioner with the survivorship program at TJCH. “Physicians can refer patients to the nurse practitioner or continue to follow patients themselves, and we will support them. It’s their choice.”
“A successful survivorship system must connect and engage the oncologist and the patient with the primary care physician,” Castle added. “So often, primary care physicians are left out of the loop, with potentially serious consequences.”
The survivorship program at TJCH is managed using the web-based Equicare CS(TM) survivorship management software, which Varian Medical Systems (Palo Alto, CA), on of the sponsors of the meeting, supplies by arrangement with Cogent Health Solutions. It begins with creation of a customized care plan that is provided to patients at the time of discharge or when active treatment is concluded. This plan includes a summary of all treatment delivered and a lifetime schedule for follow-up screenings and appointments. It provides information about the short- and long-term treatment side effects that could occur. It includes individualized guidance about diet and exercise. The plan even includes referrals to support services appropriate to the individual.
Survivors being followed at TJCH will soon receive secure access to their individual care plans over the Internet. “Having the plan online will enable two-way interaction between survivors and healthcare providers,” Cox said. “Primary care physicians will also have a secure portal where they can view their patients’ care plans and obtain information about post-treatment issues they may be experiencing.”
“Our aim is to create a lifetime connection to our survivors,” Castle added. “We see the survivorship program as a means to grow loyal patient relationships. Meeting the demands of survivors for individualized follow-up care is likely to increase their satisfaction and their well-being. Furthermore, better follow-up care and earlier intervention when health problems do arise can lower the overall long-term cost of healthcare for survivors.
 Ornish, D. et al. Intensive lifestyle changes may affect the progression of prostate cancer, J Urol. 2005 Sep;174 (3) 1065-9.
 Myerhardt et al. Association of dietary patterns with cancer recurrence and survival in patients with Stage III colon cancer. JAMA, 2007, Aug 15, 298 (7); 754-764.