Helen came to see me for her three-year check-up following treatment for her early-stage breast cancer. She had chosen to conserve her breast, had surgery that included a lumpectomy and removal of a couple of lymph nodes from her underarm, had received radiation treatments to her whole breast and was currently taking an estrogen-blocking drug belonging to a family of drugs called aromatase inhibitors. She told me she still experienced twinges of pain in her treated breast, as well as joint pains — a common side- effect of the AIs.
She left the office that day happy to know that her physical examination, blood work and breast imaging were all negative; she had no evidence of recurrence.
[See: 7 Innovations in Cancer Therapy.]
Cancer has become a more survivable disease. Even if one has not experienced cancer personally, most people will have a friend or relative like Helen who has gone through cancer treatment. The most recent figures published by the American Cancer Society report a 25 percent decline in death rates due to cancer from 1991 to 2014. This translates to a drop in cancer-related deaths from 215 per 100,000 people to 161 per 100,000. The chance of dying from four common cancers — lung, prostate, colon/rectum and breast — has seen a rapid decline. The result of this progress is an ever-increasing number of cancer survivors in the U.S. “Cancer survivor” is defined as anyone with a history of cancer from the time of diagnosis through the rest of life. It is estimated that there were 15.5 million cancer survivors in the U.S. in 2016. That number is expected to rise to 20.3 million by 2026. Nationwide, survivors of breast cancer will number over 4.5 million in 10 years, compared to more than 3.5 million in 2016.
While the change in these numbers is impressive, it also means that more people are experiencing the challenges of the side effects of cancer treatment and wondering what their life after cancer treatment — and their cancer follow-up — will look like.
Survivorship care is a recognized component of the overall arc of cancer care. The American College of Surgeons Commission on Cancer sets standards for delivery of cancer care. One of these standards is the delivery of a Survivorship Care Plan, or SCP, to the patient at the end of their curative treatment (excluding treatment with drugs that block the production of estrogen or the effects of estrogen, commonly given for five years). Over a decade ago, in 2005, the Institute of Medicine recommended that every cancer patient should receive an individualized SCP and guidelines for monitoring and maintaining their health.
The SCP has defined patient-centered elements, including a comprehensive summary of cancer treatment received and recommendations for follow-up.
[See: How Social Workers Help Your Health.]
Key Elements of a breast cancer SCP (such as the one that Helen received) should include:
The Treatment Summary:
— Information on tumor characteristics, including site, stage, grade and prognostic factors
— Details on cancer treatment
— Type of treatment (breast cancer surgery, reconstructive surgery, chemotherapy, radiation therapy, hormonal therapy, biologic targeted therapy and other treatments)
— Agents used (drug regimen, total number of treatment cycles, total dosage received)
— Dates of treatment
— Information on genetics and family history
— Serious side effects, both short-term and long-term
— Support services provided or referred (psychological, rehabilitation, nutritional support, vocational, other)
— Contact information for treating institutions and key individual providers
The Follow-Up Care Section of the SCP May Include:
— Possible late and long-term effects of treatment and their symptoms
— Possible sexual dysfunction effects from treatment, their symptoms and ways to manage them
— Possible psychological effects and potential need for psychological support
— Referral services related to insurance, employment and/or financial issues
— A list of medications/substances that the survivor should not take
— Need for ongoing health maintenance with specific recommendations for lifestyle changes to promote health and reduce risk of cancers and chronic disease
— Referrals/resources as necessary to support the patient in achieving these lifestyle behavior changes, such as smoking cessation and weight management
[See: 10 Lessons from Empowered Patients.]
According to the American College of Surgeons National Accreditation Program for Breast Centers, it’s recommended that patients like Helen receive their care plan within six months of completing active treatment and no longer than one year from date of diagnosis.
If you or a loved one has undergone cancer treatment and has not received a Survivorship Care Plan, please ask your oncologist to provide one. It is a valuable reference and resource — a roadmap for recovery.
More from U.S. News
7 Innovations in Cancer Therapy
Breast Pain? Stop Worrying About Cancer
Surviving Cancer: What Cancer Survivors Should Know About Survivorship Care Plans originally appeared on usnews.com
