The ACSC aims to provide timely and relevant information for health professionals on important issues related to cancer survivorship.
About cancer survivorship
With improvements in cancer detection and treatments coupled with an ageing population, there are increasing numbers of people living with and beyond cancer.
- In 2016 it was estimated that 1.1 million Australians have a personal history of cancer, including 256,000 Victorians.
- Cancer survivors can experience significant consequences from their cancer treatment, impacting on their physical, emotional and psycho-social health.
- During the period 1988–2012, five-year survival in Victoria increased from 48 to 67 per cent.
- In Victoria, nearly half of cancer survivors (46 per cent) are aged over 70, a population with a high proportion of comorbidities.
Cancer Council Victoria provides recent statistics about the number of cancer survivors in Victoria in the ‘Cancer Facts’ series.
A variety of definitions of cancer survivorship have emerged in recent years. Each definition emphasises the ongoing unique needs of people who have experienced a diagnosis of cancer. In Australia, survivorship is generally considered to be the phase after completing initial treatment.
“The term cancer survivor refers to a person who has been diagnosed with cancer, from the time of diagnosis throughout his or her life. The impact of cancer on family members, friends, and caregivers of survivors is also acknowledged as part of survivorship.” (Centres for Disease Control and Prevention)
- Resources to support practice
- Survivorship guidelines
- Survivorship care plans
- Victorian Cancer Survivorship Program
- Survivorship education and training
- Australian Cancer Survivorship research
Elements of survivorship care
The landmark US Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition highlights the need for models of survivorship care to include:
- prevention of new and recurrent cancers and other late effects
- surveillance for cancer spread, recurrence or secondary cancers
- assessment of late psychosocial and medical effects
- interventions for consequences of cancer and treatment
- coordination between primary care providers and specialists.
The Institute of Medicine made key recommendations for improving survivorship care including:
- implementing self-management skills training
- developing and using survivorship care plans (SCPs)
- adopting alternative models of care.
Models of survivorship care
Increasing evidence is emerging about the types of service delivery models that will support implementation of the key elements of survivorship care. The American Society of Clinical Oncology (ASCO) has recommended that approaches to cancer survivorship care should:
- promote successful models of survivorship care and tools that optimise the transition process between oncology and primary care providers
- promote a shared-care model for survivorship care that includes communication between the oncology specialist and primary care provider and successful transition of the patient from the oncology setting to primary care setting post treatment using a risk-stratified approach as part of the SCP
- partner with other organisations to support demonstration programs to test models of coordinated, interdisciplinary survivorship care in diverse communities and across systems of care.
In the UK, the Stratified Pathways of Care model describes three forms of care, depending on a risk and needs assessment and the person’s wishes:
- Supported self-management. The survivor is supported by health professionals, carers and the health system to manage their condition. This incorporates health promotion, risk reduction, informed decision making, care planning, medication management and working with healthcare providers to attain the best care and negotiate the health system. It is recommended that ALL survivors be equipped with self-management skills.
- Shared care. In addition to the above, survivors have face-to-face phone or email contact with primary care providers and cancer specialists. GPs need to be well resourced and understand their responsibilities to take on the coordinating role, and need good communication with the oncology team. Treatment summaries and SCPs can be effective communication tools between oncologists and GPs.
- Complex case management. Survivors are given intensive support to manage their cancer and/or other conditions. This might be through a multidisciplinary team or a long-term follow-up or late effects clinic.
Designing efficient cancer follow-up to meet individual needs is supported by stratifying patients according to risk, tumour type, treatment and personal circumstances. Risk stratification is defined as the process of quantifying the probability of a harmful effect to individuals resulting from a range of internal and external factors (demographic characteristics and/or medical treatments).