After cancer care needs improvement
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Cancer survival rates in the United States has dramatically increased in the past forty years as a result of improved prevention, detection and treatment.

The newest treatments are training the immune system to hunt tumor cells, medications are keeping cancer growth in check, and policy efforts like the Vice President's Cancer Moonshot are helping bridge all of those efforts into a unified assault. Yet surviving cancer is just the first challenge.

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Many Americans emerge from treatment facing struggles far beyond their illness.  Some survivors have minimal pain and disability, some are completely debilitated, and a great number lie in between.

A few common challenges cancer survivors confront include physical concerns (fatigue, pain or changes in appearance or memory) or emotional distress such as depression or fear of recurrence. There are often financial, employment and legal implications of cancer treatment and survival.

Some of the most devastating effects impact survivors' closest relationships, from the care demands placed on spouses to the loss of fertility or post-traumatic stress often experienced by parents of pediatric cancer survivors. Cancer survivors who are treated before or during their reproductive years may have lost a chance to have a family before they even had time to consider one. There is no medical reimbursement to bank sperm or eggs.  

More Americans are defeating cancer every year, an incredible gift to so many — but beyond initial treatment, there are real gaps in the support system. Too many cancer survivors are unable to access the treatments and supportive care resources to improve quality of life and wellness. Unfortunately, for most Americans, those resources are unavailable either due to a lack of access or lack of insurance. The United States healthcare system is woefully unprepared and underfunded to provide these supportive services to cancer survivors and their caregivers. 

The problems aren't new: In 1996, the medical community began a culture shift from viewing cancer patients as victims to seeing them as survivors. The National Cancer Institute started the Office of Cancer Survivorship in that year to guide impact through research and education. That effort soon gained momentum from the private sector, with such movements as the LIVESTRONG foundation and its omnipresent yellow wristbands.

In 2006, the Institute of Medicine released the groundbreaking "From Cancer Patient to Cancer Survivor" report, presenting the essential components of survivorship and highlighting how too many patients get lost in the coordination of care. Since the release of that report, the American College of Surgeons Commission on Cancer set accreditation criteria that have driven significant changes.

Treatment summaries have become a requirement so patients can take their histories with them, allowing primary care doctors to monitor for late-emerging side effects. Facilities are now required to screen patients for distress, helping manage emotional crises before they become debilitating. And palliative care has become an established medical discipline.

It is imperative that cancer treatment be patient-centric and holistic, focusing on supportive care needs rather than strictly disease focused. The United States is in a position to lead the world in cancer survivorship, not just treatment. By bringing together experts from a range of disciplines, survivorship and palliative care can work, helping patients overcome the most devastating effects of their disease.

Every cancer survivor should have access to a veritable army of support that includes oncologists, primary care providers as well as supportive care experts including survivorship and palliative care providers. Beyond simple monitoring, these experts provide guidance. There should be a comprehensive system to promote healthy living and wellness that is reimbursed to encourage healthy behaviors and healthy coping.

Every cancer survivor should have access to mental health providers, support groups, career and legal advice as well as the opportunity to participate in oncology rehabilitation. Survivorship is more than predicting or anticipating medical complications — it is a unified system of psychosocial, spiritual and emotional care.

There is evidence that demonstrates this support is effective and can reduce morbidity and, in some cases, extend life. At The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute researchers have found that practicing yoga for as little as three months twice a week can reduce fatigue and lower inflammation in breast cancer survivors.

This reduction in inflammation is significant.  That is because chronic inflammation is linked to the frailty and functional decline that often times accompanies aging and to numerous serious health conditions such as type 2 diabetes, heart disease, arthritis and Alzheimer’s. Another study at OSU showed that stress reduction for caregivers could extend life by 4 to 8 years. Stress reduction also has been shown to reduce the size of cancerous tumors. 

Additional research done in the field of palliative care shows that lung cancer patients who have early palliative care along with standard of care treatment for their cancer actually live longer than patients who do not have palliative care.

We are winning the war on cancer one patient at a time, and it has been one of the greatest triumphs of modern medicine, but now the survivors are returning home and they need our support. Cancer treatment has evolved, and it is time for the United States healthcare system to evolve with it. We must give our patients the support they need to thrive.

Janet Snapp, MSN, RN, FPCN is a Service Line Administrator, Patient Support Services and Dori Klemanski, DNP, CNP is the Clinical Director of Survivorship at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. 


The views expressed by contributors are their own and not the views of The Hill.