With advances in treatment and screening for earlier detection, oncologists have improved cancer survival rates dramatically. That is excellent news, but the surging number of survivors means it is increasingly important for providers to focus more diligently on what patients need to thrive after treatment.
In 2022, there were more than 18.1 million cancer survivors in the U.S., and by 2032, there will be more than 22.5 million, spotlighting the need to focus more closely on survivor quality of life.
Survivors often experience mental and emotional struggles after treatment due to stress and anxiety and sometimes experience permanent disfigurement from surgical procedures. According to a study in JAMA Otolaryngology – Head & Neck Surgery, the suicide rate for head and neck cancer patients is almost four times that of the general US population. The study attributes this to changes in patients’ appearance after surgery, difficulty swallowing, or the need for devices to help them speak. Suicide rates for other cancers are also higher. A study in JAMA Network Open studying patients from 43 states diagnosed with cancer from 2000-2016 found suicide risk was 26% higher compared with the general population.
This issue leaves my colleagues and me wondering how we can better collaborate to ensure survivors have access to the behavioral and physical resources they need to thrive and regain their pre-diagnosis quality of life.
Nationwide, there is a shortage of oncologists. This has forced oncologists to limit their practice to patients only undergoing workup or treatment. Consequently, cancer survivorship programs that incorporate support from other medical community members are the best way to address the needs of this rapidly increasing population.
Oncologists’ primary responsibilities after treatment are ensuring patients consistently attend their follow-up visits and receive screening and prevention as recommended, leaving primary care physicians (PCPs) as the leading health care providers moving forward. Considering the growing number of survivors who may only require only sporadic oncology office visits, there is a need for better collaboration between PCPs and treating oncologists. Survivorship is fluid and extends from oncology to primary care and all points between. This is why developing innovative survivorship programs to follow cancer care is vital.
Thanks in part to funding from the National Cancer Institute (NCI), at Karmanos, we offer survivors many programs to help. Our CAPABLE program (Cross-Training and Physical Activity: A Better Life Experience) is a free 12-week exercise program that provides a chance for survivors of all fitness levels and abilities to meet current consensus recommendations for physical activity, monitored by professional trainers and partnered with our oncology and primary care providers. This program uses a high-intensity interval and strength training (HIIST) approach, where trainers meet participants at their current fitness level, and they may perform these exercises at their own pace. Program participants do not have to be patients at Karmanos to participate. The CAPABLE study, published in Preventative Medicine, found that survivors in the classes benefited from weight loss and improved HbA1c levels, and participants were able to strengthen their ability to do functional movements required for everyday living. Participants also built community and social support among their fellow cancer thrivers while participating in the classes. Similar programs to CAPABLE are available at other institutions.
There are 57 NCI-Designated Comprehensive Cancer Centers nationwide, and almost all offer cancer survivorship programs. Just like Karmanos, centers with this designation offer programs that connect survivors with cancer research initiatives and provide psychology and psychiatry services for patients and their families for as long as they need them following treatment. Though centers with this designation are located across the country, gaining access to their specialized services may be difficult for survivors not located nearby. Therefore, more survivorship resources are needed at the community level.
We know no single survivorship program can meet every patient’s needs. What works best for our patients is screening for needs and providing tailored management. We have worked diligently at our organization to connect those dots for patients. We hope our programs offer examples of what’s possible and inspire other organizations to fill the gaps in post-cancer support.
I encourage hospital and health system leaders across the country who do not already offer similar services to develop and support cancer survivorship programs tailored to the needs of this growing population. These can include a thorough follow-up program implementing national guidelines related to supportive care, emotional well-being, management of treatment-related toxicities, distress management, cancer-related fatigue, and cancer screening, to name a few. Offering these programs at no cost to cancer survivors may increase participation numbers and help health systems prove their community benefit.
Receiving a cancer diagnosis is life-changing, and undergoing cancer treatment is beyond challenging, both physically and emotionally. Cancer survivors deserve more. This additional support should be part of health care delivery, and we can work together to ensure it becomes standard care.
Boris Pasche, M.D., Ph.D., FACP, is president and CEO of the Barbara Ann Karmanos Cancer Institute.
Originally published by The Cancer Letter.