Survivorship research: informing life and care after cancer
Julia Rowland
Office of Cancer Survivorship, National Cancer Institute, NIH/DHHS, Maryland, USA
As we race into the new millennium, increasing attention is being given to the emerging field of cancer survivorship. A number of factors are driving this interest. Arguably, the most compelling of these is the growing population of individuals living with a history of cancer. Currently estimated as numbering almost 25 million globally, today’s cancer survivors are a testament to the many successes achieved in our ability to cure and control the complex set of diseases called cancer. At the same time, these individuals represent a challenge to the clinical and research communities to look beyond the search for a cure and provide hope for a valued future for those living with, through and beyond cancer.
In response to this challenge, scientists and clinicians are rapidly developing ever more sophisticated ways to evaluate and describe the consequences of long-term survival. As this science matures, survivorship research is revealing that few cancer therapies are benign, and many have significant chronic or late occurring toxicities. All aspects of a survivor’s life and function may be affected: physical, psychological, social, economic, existential or spiritual. This information is helping to inform the design and delivery of interventions that prevent or mitigate cancer’s adverse effects on survivors’ health outcomes.
As survivors seek ways to reduce their risk of morbidity and mortality secondary to illness, they expect their healthcare providers to help them in their search. For many, cancer represents a ‘teachable moment,’ a time when healthcare providers can engage survivors in lifestyle and other behaviour change with the potential to enhance their future well-being. To fully realize this opportunity, however, a new paradigm is needed in providing cancer care. This model: a) recognizes that survivorship issues begin at time of diagnosis, b) acknowledges that the patient is as important as the tumour in planning care, c) addresses psychosocial needs across the course of illness and recovery, and d) emphasizes disease prevention and health promotion. The ultimate goal of this new model of cancer care is not simply to extend life, but importantly, to improve the quality of the life that is lived.