Cancer Survivorship: Is There aRole for Cancer Survivor Clinics?

The population of survivors of cancer is increasing world-wide. In Italy, 2,243,953 patients (4% of the Italian pop-ulation) survived after a cancer diagnosis in 2006.1

The drafting of survivorship care plans (SCPs), con-sisting of a written treatment summary and a follow-upcare plan (addressing cancer recurrence, primary and sec-ondary cancer prevention, and the management of com-mon long-term and late cancer and/or treatment effects),is regarded by both the Institute of Medicine2 and theAmerican Society of Clinical Oncology3 as an essentialstep in the care of survivors of cancer.

This is certainly true within the context of a collabo-ration and information sharing between survivors, oncol-ogy providers, and primary care physicians, with theultimate goal of fostering the long-term health of thesurvivors.

However, Salz et al4 recently reported in Cancer thatalthough oncology providers have positive feelings regard-ing SCPs, only 52% of them ever provided any compo-nent of an SCP to their patients. As suggested by theauthors, the reasons for this behavior are attributable to:1) the lack of time and staff; 2) the failure to identify thetype of information to be included in the SCPs; 3) doubtsconcerning the relevance of SCPs to survivors of cancer;and 4) the lack of reliable data demonstrating animproved outcome resulting from SCPs. Ultimately, thelack of integration of SCPs into clinical practice is due tothe absence of definite guidance regarding what consti-tutes standards of care for survivors of cancer.

Moreover, it is intriguing to note that, within thecontext of pediatric cancers, for which the mature dataarising from a long period of follow-up led to the develop-ment of guidelines for the screening and prevention ofcancer and/or treatment side effects, the results of a recentreport5 have emphasized the lack of comfort among gen-eral internists with available surveillance plans and thepreference to follow patients in collaboration with cancercenters.

We propose the establishment of cancer survivorclinics (CSCs),6,7 which consist of health professionals (ie,medical oncologists; radiation therapists; psychologists;nurses; and other physicians such as cardiologists, gyne-cologists, and urologists) dedicated to the care of survivorsof cancer and willing to assume a leadership role in the

drafting of SCPs. The number of these CSCs should beplanned in relation to the estimated number of survivorsof cancer in each country and designed within the medicaloncology departments.

CSCs should assess: 1) the occurrence of any knownside effects from cancer or its treatment (ie, neurocogni-tive problems, premature menopause, infertility, cardior-espiratory system dysfunctions, and chronic fatigue); 2)the concomitant presence of comorbidities and theirinfluence on the patient’s general health status; 3) psycho-logical disturbances (ie, fear of cancer recurrence, anxiety,depression, and body image perception disorders); and 4)problems regarding social and employment reintegration.Moreover, CSCs should provide screening guidelines forcancer recurrence and second primary tumors, designproper clinical follow-up pathways, promote behavioralchanges (ie, smoking cessation and alcohol intake reduc-tion), and improve screening and prevention programsfor the relatives of cancer survivors. In particular, CSCsshould focus on the care of long-term survivors of cancerwho we have previously defined as disease and treatmentfree for at least 5 years.7

We propose a 1-time consultation model of survi-vorship care in which survivors at the end of the treatmentphase should be referred to CSCs that will define person-alized follow-up care plans based on different risks of dis-ease recurrence and late side effects of cancer and/or itstreatments. Further consultations should be definedaccording to the individual needs of survivors.

Communication between CSCs and primary carephysicians should be encouraged and CSCs shouldassume a coordinating role between survivors, their rela-tives, and primary care physicians in the promotion of anincreased awareness of the unique aspects of survivorshipcare.

Moreover, we believe that CSCs play some unique

roles that cannot be performed by primary care practi-

tioners. Particular among these is psychological supportfor survivors of cancer and their families, with the aim of

facilitating social rehabilitation, employment, and educa-

tion through the promotion of meetings and seminars

and the sharing of information regarding several aspectsof survivors’ health.

Finally, as part of a health policy aimed at reducingunnecessary expenditures, we believe that the establish-ment of CSCs will not represent additional costs becausethey are specifically designed to avoid the redundancy ofinterventions and to respond to specific needs. Studies of

1908 Cancer June 15, 2014

Correspondence

cost-effectiveness should be encouraged to confirm thisbelief.

FUNDING SUPPORTNo specific funding was disclosed.

CONFLICT OF INTEREST DISCLOSURESThe authors made no disclosures.

REFERENCES1. AIRTUM Working Group. Italian cancer figures, report 2010: cancer

prevalence in Italy. Patients living with cancer, long-term survivorsand cured patients [in English, Italian]. Epidemiol Prev. 2010;34(5-6suppl 2):1-188.

2. Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Can-cer Survivor: Lost in Transition. Washington, DC: National Academ-ies Press; 2005.

3. McCabe MS, Bhatia S, Oeffinger KC, et al. American Society ofClinical Oncology statement: achieving high-quality cancer survivor-ship care. J Clin Oncol. 2013;31:631-640.

4. Salz T, McCabe MS, Onstad EE, et al. Survivorship care plans: is therebuy-in from community oncology providers [published online ahead ofprint December 10, 2013]? Cancer. doi: 10.1002/cncr.28472.

5. Suh E, Daugherty CK, Wroblewski K, et al. General internists’preferences and knowledge about the care of adult survivors ofchildhood cancer: a cross-sectional survey. Ann Intern Med. 2014;160:11-17.

6. Tirelli U, Spina M, Augello AF, Berretta M, Annunziata MA,Bongiovanni M. Is it better to transfer long-term cancer survivors togeneral practitioners or develop clinics for long-term survivors withinthe cancer centers? J Clin Oncol. 2014;32:257.

7. Simonelli C, Annunziata MA, Chimienti E, Berretta M, Tirelli U.Cancer survivorship: a challenge for the European oncologists. AnnOncol. 2008;19:1216-1217.

Ernesto Zanet, MDUnit of Cell Therapy and High Dose Chemotherapy

Centro di Riferimento Oncologico (CRO) Aviano National Cancer InstituteAviano, Italy

Mariagrazia Michieli, MDUnit of Cell Therapy and High Dose Chemotherapy

Centro di Riferimento Oncologico (CRO) Aviano National Cancer InstituteAviano, Italy

Umberto Tirelli, MDDivision of Medical Oncology A

Centro di Riferimento Oncologico (CRO) Aviano National Cancer InstituteAviano, Italy

DOI: 10.1002/cncr.28658, Published online March 11, 2014in Wiley Online Library (wileyonlinelibrary.com)

Correspondence

Cancer June 15, 2014 1909