American Society of Clinical Oncology Statement: Achieving High-Quality Cancer Survivorship Care

Abstract

Over the past several decades, the number of cancer survivors has increased dramatically as a result of improved early detection of first malignancies and effective therapies. There are more than 13 million cancer survivors in the United States today.1 This number is expected to reach 18 million by 2022.1 These data underscore the public health magnitude of cancer survivorship and the importance of efforts to characterize and address the health concerns of cancer survivors. Although the cancer survivorship population is heterogeneous, many survivors face distinct and serious health care issues. Cancer survivors are at increased risk for long-term morbidity and premature mortality, related directly to the cancer itself, to pre-existing comorbidities, and to exposure to therapy. The risk-benefit ratios for many of the methods of disease prevention, screening, and treatment may be shifted in survivors because cancer- and treatment-related changes can lead to premature development of age-related changes, atypical presentations of common health conditions, an increased risk of developing these health conditions, and poor response to treatments that are usually effective for these conditions. Additionally, the higher prevalence of coexisting comorbidities in the elderly may become further exacerbated because of treatment. As a result, the many patients who become survivors will require preventive and general medical care subsequent to their cancer-related care. Cancer survivors are an important group to receive risk assessment and prevention services, and oncologists are increasingly providing counseling and services to that group. In a 2004 survey of American Society of Clinical Oncology (ASCO) members, roughly three quarters of oncologists said they believe they should be involved in the ongoing care of patients who are survivors of cancer, including general health maintenance, screening, and prevention.2 However, only 60% said they feel comfortable providing these services.2 The survey also suggested that oncologists define their role in cancer prevention and risk assessment quite broadly and beyond providing services in their own practices.2,3 As more patients with cancer transition back to primary care, many groups have identified the need for greater coordination of care and increased attention to health promotion and disease prevention in survivors. These organizations are looking to oncology professionals to develop a coordinated strategy for providing follow-up medical care to the growing population of cancer survivors. As the leading medical professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care, ASCO is committed to improving the care of cancer survivors. ASCO first established a Cancer Survivorship Task Force in 2004 to address the growing issues related to cancer survivorship. In 2005, the task force led the ASCO partnership in cosponsoring a symposium on cancer survivorship with the Institute of Medicine (IOM) to chart a course for care of cancer survivors and fill gaps in patients' long-term care. This workshop focused on implementation of the 10 recommendations contained in the IOM report “From Cancer Patient to Cancer Survivor: Lost in Transition.”4 An outcome of the symposium was the prioritization of several key ASCO initiatives, including development of cancer treatment plan and summary templates, establishment of the Patient and Survivor Care Track at ASCO annual meetings, development of a survivorship guideline addressing fertility preservation, inclusion of survivorship topics in the ASCO core curriculum, and publication of numerous survivorship articles in ASCO publications. Additionally, ASCO partnered with the National Coalition for Cancer Survivorship to establish the Cancer Quality Alliance in response to the IOM call for public-private partnerships to monitor and improve the care that survivors receive. In 2011, ASCO established the Cancer Survivorship Committee to provide long-term leadership and oversight of its growing number of cancer survivorship activities. In the past year, the committee has been working with appropriate groups within and outside of ASCO to enhance the quality and quantity of initiatives addressing cancer survivorship. The committee has developed a comprehensive agenda to assist ASCO members in the delivery of quality survivorship care. The objective of this statement is to present ASCO recommendations for improving the care of cancer survivors and the role of ASCO in this important endeavor, as envisioned by the Cancer Survivorship Committee. Specific efforts will be concentrated on developing guidance for oncology care providers on the clinical management of cancer survivors, increasing collaboration between oncologists and primary care providers (PCPs) in the provision of cancer survivorship services, improving health professional education and training, increasing patient and family education and self-advocacy, supporting research on cancer survivorship, and promoting policy change to ensure cancer survivors have access to appropriate health care services, including improving the payment environment so that adequate, uniform reimbursement for prevention counseling, interventions, and therapies is provided by payers. It is important to note that ASCO endorses the National Coalition for Cancer Survivorship definition of a cancer survivor as starting at the point of diagnosis. However, for the purposes of this discussion, a functional definition of survivorship will be used, focusing on individuals who have successfully completed curative treatment or those who have transitioned to maintenance or prophylactic therapy (eg, individuals receiving hormonal therapy after cytotoxic therapy for breast cancer).