Cancer survivorship = long-term condition management

Abstract

United Kingdom (UK) data indicate that there are currently approximately 2.5 million people living with and beyond cancer, and it is estimated that this figure will rise to 4 million by 2030 (Macmillan Cancer Support, 2015; Cancer Research UK, 2015). Reasons for this are linked to advances in earlier diagnosis and the availability of more effective cancer treatments. Additionally, as with other developed countries, the UK has an ageing population – and as we age we are at increased risk of having cancer. These factors, in combination, already and increasingly will result in a significant increase in the number of people living with and beyond cancer, often referred to in the literature as ‘cancer survivors’. Increased survival rates are good news for this patient population yet, culturally, there seems some way to go before the rehabilitation needs of those living with and beyond cancer are recognised. Still to be achieved is a parity of provision in line with other services linked to long-term conditions such as neurology (Robb and Davis, 2015). To provide such services, strong leadership skills and a desire to do things differently will be needed, raising the profile of cancer as a global health concern in line with other non-communicable diseases. The International Agency for Research on Cancer (IARC), established in 1965 and funded within the framework of the World Health Organization (WHO), goes some way to supporting this. The IARC’s function is to conduct research, provide cancer research education and report on cancer-related matters at a global level. In 2014, the IARC published incident rates for all cancers across the five continents after collecting data from the International Association of Cancer Registries, whose 700 member registries includes England, Northern Ireland, Scotland, Wales and Ireland (Forman et al., 2015). These data are considered important to provide nations with information linked to the incidence and economic burden of cancer and therefore, impact positively on policy development and service planning. Additionally, data can be used to research possible causes and trends in cancer incidence and the potential benefit of treatment interventions. Importantly, the IARC’s work is accessed at the highest political levels across the five continents concerned. In order to meet patient needs therefore, it is important for us to consider cancer survivorship as a long-term condition, which will enable survivors to access high quality, evidence-based cancer rehabilitation services. Occupational therapists and other health and social care practitioners are encouraged to take up the challenge to create opportunities to work in cancer survivorship along the emerging cancer pathways. These pathways are beginning to span the disease course from the diagnosis and pre-treatment phases in terms of pre-ablement, in addition to including the acute and/or end-of-life phases, where our practice has more traditionally been focused. As a profession, this is the time for us to recognise and have confidence in transferring our excellent knowledge and skills in managing long-term conditions, incorporating life-style management and redesign, to address the current and predicted demands of cancer survivors. The needs of cancer survivors are frequently complex and require input from an inter-professional team. This ensures individual patient needs are addressed as practitioners step on and off emerging pathways of care to tailor interventions. The ability to influence those in positions of power within your own organisations, such as executive teams, and externally, such as commissioners, can support effective change. Publications such asCancer Rehabilitation: Making Excellent Cancer Care Possible (National Cancer Action Team, 2013) and the Allied Health Professions Cancer Care Toolkit: How AHPs Improve Patient Care and Save Money (NHS London, 2012) can be used to support proposed changes and innovations. Some 3 years ago, as a clinical lead for the inter-professional Bath Centre for Fatigue Services and using the