Cancer Survivorship and Palliative Care?

Cancer Survivorship and Palliative Care?

Paul C. Rousseau, MD

I’ll give you my strength if I can have your remission.—John Green, The Fault in Our Stars

Dear Editor:Denise had survived chemotherapy, radiation, repeated sur-

geries, and a rectal abscess. She was now a cancer survivor.But all was not well.While thankful for the respite of survival, survivorship

came with a burden—uncertainty and the fear of recurrence.Remission had turned Denise’s life into episodes of worrycoupled with traumatic remembrances of treatment. The fearof recurrent cancer controlled her life.

Unfortunately, what Denise experienced is not uncommon.Survivorship with a fear of cancer recurrence (FCR) is one ofthe greatest unmet needs of cancer patients. In fact, thereappears to be no calendar boundaries for the development ofFCR—it can occur years after initial diagnosis.1,2 And with arevised model of cancer survivorship that now includes long-term disease-free survival,3 the incidence of FCR will onlyincrease.4

Since survivorship programs are not universally available,primary care providers will likely be the caregivers for mostof these patients, but should palliative care be part of theteam? I would argue yes. Admittedly, the definition of pal-liative care has been confined to treatment of patients with alife-threatening or terminal illness; however, patients withFCR frequently exhibit symptoms that palliative care clini-cians see and evaluate on a daily basis, including pain, nau-sea/vomiting, neuropathy, anxiety, depression, and anorexia.

I believe palliative care would bring much to the therapeutictable by helping to manage the complexities of the physicaland mental health of cancer survivors, including late com-plications of cancer treatment, and in so doing, improvefunctioning and well-being of survivors and their families.5

References

1. Sebastien S, Thewes B, Humphris G, et al.: Fear of cancerrecurrence in adult cancer survivors: A systematic review ofquantitative studies. J Cancer Surviv 2013;7:300–322.

2. Koch L, Jansen L, Brenner H, et al.: Fear of recurrence anddisease progression in long term ( > 5 years) cancer survi-vors: A systematic review of quantitative studies. Psycho-Oncology 2013;22:1–11.

3. Gosain R, Miller K: Symptoms and symptom managementin long term cancer survivors. Cancer J 2013;19:405–409.

4. Crist JV, Grunfeld EA: Factors reported to influence fear ofrecurrence in cancer patients: A systematic review. Psycho-Oncology 2013;22:978–986.

5. Ganz PA: Monitoring the physical health of cancer survi-vors: A survivorship-focused medical history. J Clin Oncol2006;24:5105–5111.

Address correspondence to:Paul C. Rousseau, MD

81 On The Harbor DriveMount Pleasant, SC 29464

E-mail: palliativedoctor@aol.com

Palliative and Supportive Care Program, Medical University of South Carolina, Charleston, South Carolina.

JOURNAL OF PALLIATIVE MEDICINEVolume 17, Number 9, 2014ª Mary Ann Liebert, Inc.DOI: 10.1089/jpm.2014.0159

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