Summary
There is a growing focus on survivorship care in the cancer community; however, some patients may feel left out of the conversation.
“There was a practical shift to look at survivorship from the end of curative intent therapy with the [growing] importance of a survivorship care plan,” noted Don S. Dizon, MD, Director of Women's Cancers, Lifespan Cancer Institute. “The unintended consequence was that we started defining survivorship in a very specific way and, as a result, folks who are living with cancer or still undergoing any kind of therapy didn't see themselves in this definition and, hence, it didn't feel like a care plan that spoke to their needs.”
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Original Article
The Role of Survivorship in Breast Cancer Treatment
Oncology Times
By Catlin Nalley
There is a growing focus on survivorship care in the cancer community; however, some patients may feel left out of the conversation.
“There was a practical shift to look at survivorship from the end of curative intent therapy with the [growing] importance of a survivorship care plan,” noted Don S. Dizon, MD, Director of Women's Cancers, Lifespan Cancer Institute. “The unintended consequence was that we started defining survivorship in a very specific way and, as a result, folks who are living with cancer or still undergoing any kind of therapy didn't see themselves in this definition and, hence, it didn't feel like a care plan that spoke to their needs.”
Dizon shared his insights on this issue and how to incorporate survivorship during his session, “Survivorship Starts at Diagnosis,” at the Miami Breast Cancer Conference.
Addressing Survivorship
Survivorship is a dynamic process, according to Dizon, and the individual needs of the patients must be taken into consideration. “With the Commission on Cancer taking the steps to look at survivorship more globally, there is a growing understanding that survivorship can’t be relegated into a one-time-fits-all care plan,” he noted.
Work from the Lifespan Cancer Institute has shown that even at initial presentation there is a significant proportion of patients who come in with distress, according to Dizon. “This is before they've even had any treatment,” he explained. “And this includes things that we sometimes attribute to cancer therapy as the reasons they are distressed, such as trouble with memory and concentration, depression, worry and anxiety, as well as treatment decision-making.
“Life is not the same after you've been told you have cancer,” he emphasized. “Therefore, it makes sense to a growing number of us in this field that we need to refocus our efforts on how to meet the needs of people after their diagnosis has been made. What we're championing here is the idea of instead of a survivorship care plan, what does a life care plan look like?”
How can cancer care providers better address these issues? According to Dizon, some of this work is already being done through daily practice.
“My surgical colleagues do this when they talk about surgery for breast cancer, including reconstruction options,” he explained. “We are already talking about issues that women are going to care about, not only in the present, but also things that will impact their lives moving forward. In medical oncology, we do speak to patients—and we should be doing a better job of it—regarding issues of fertility preservation for women of reproductive age.
“And so, while we are doing some of this work, what we need to look at more globally is a comprehensive understanding of patients and where they are at each point of that cancer trajectory,” he continued. “For instance, it's an acute survivorship when someone is dealing with a new diagnosis and there are particular challenges in that area that fall on those who are involved in that acute care period to ensure they're addressed.”
Dizon posed the question: Is it possible to broaden how we look at the issues we deal with in our respective fields?
“For my colleagues who are surgeons, it's not only discussing reconstruction, but there is a subgroup of women who really don't want to have a mastectomy with reconstruction,” he explained. They are opting not to do reconstruction and it is important to acknowledge that this is actually a reasonable and conscious decision.
“For medical oncologists, it is making sure that discussions regarding fertility preservation are happening,” he continued. “It’s ensuring that any psychological concerns are recognized at that point of diagnosis and beyond. We want patients to be able to access help at any point and not just relegate this to the end of the curative treatment period.”
Session Takeaways
During his session, Dizon challenged attendees to rethink the whole concept of survivorship.
“I want them to walk away from the talk understanding that you don't necessarily have to be in complete remission or without evidence of disease to claim the term survivor,” he told Oncology Times. “Patients should be welcomed to access the resources that we tend to think of as needed for those who are ‘cured.’ This includes women who are living with advanced and metastatic disease whose needs are not necessarily met by traditional palliative care models.
“All patients should have access to support that includes healthy lifestyles, exercise, and nutrition,” he concluded. “Those are as important to women living with cancer as it is for those who are living without cancer.”
Catlin Nalley is a contributing writer.