Cancer Survivorship Care: Exploring the Role of the General Internist (original) (raw)

Abstract

According to the National Cancer Institute (NCI), cancer survivorship encompasses the “physical, psychosocial, and economic issues of cancer from diagnosis until the end of life.” Today, one in 30 Americans are cancer survivors. Almost two-thirds have at least one chronic health condition. As the numbers of cancer survivors increase, cancer itself can be viewed as a chronic medical condition. This paper illustrates some of the challenges faced by cancer survivors. We discuss the limitations of current models of survivorship care, including shared care. In addition, we explore how the American Board of Internal Medicine’s previously proposed credential of Comprehensive Care Internist could serve to define and integrate the complex needs of adult cancer survivors with the skills and talents of general internists.

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References

1. Sabatino SA, Coates RJ, Uhler RJ, Alley LG, Pollack LA. Health insurance coverage and cost barriers to needed medical care among U.S. adult cancer survivors age<65 years. Cancer. 2006; 10611: 2466–75.
   Article PubMed Google Scholar
2. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003; 581: 82–91.
   PubMed Google Scholar
3. Neglia JP, Friedman D, Yutaka Y, et al. Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. J Natl Cancer Inst. 2001; 93: 618–29.
   Article CAS PubMed Google Scholar
4. Mertens AC, Yasui Y, Neglia JP, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. J Clin Oncol. 2001; 19: 3163–72.
   CAS PubMed Google Scholar
5. Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer.. N Engl J Med. 2006; 355: 1572–82.
   Article CAS PubMed Google Scholar
6. Carver JR, Shapiro CL, Ng A, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors:cardiac and pulmonary late effects. J Clin Oncol. 2007; 25: 3991–4008.
   Article CAS PubMed Google Scholar
7. Oxman TE, Silberfard PM. Serial cognitive testing in cancer patients receiving chemotherapy. Am J Psychiatry. 1980; 137: 1263–5.
   CAS PubMed Google Scholar
8. Ferguson R, Ahles T. Low neuropsychologic performance among adult cancer survivors treated with chemotherapy. Current Neurology and Neuroscience Reports. 2003; 33: 215–22.
   Article PubMed Google Scholar
9. Dietrich J, Monje M, Wefel J, Meyers C. Clinical patterns and biological correlates of cognitive dysfunction associated with cancer. The Oncologist. 2008; 13: 1285–95.
   Article PubMed Google Scholar
10. Nuver JSA, Postma A, Sleifer DT, Gietema JA. The metabolic syndrome in long- term cancer survivors, an important target for secondary preventive measures. Cancer Treatment Reviews. 2002; 28: 195–214.
    Article CAS PubMed Google Scholar
11. Hewitt M, Greenfield S, Stovall E eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Improving Care and Quality of Life. Washington D.C: National Academies Press; 2006.
12. Oeffinger KC, McCabe MS. Models for delivering survivorship care. J Clin Oncol. 2006; 24: 5117–24.
    Article PubMed Google Scholar
13. McCabe MS, Jacobs L. Survivorship care: models and programs. Seminars in Oncology Nursing Health Promotion in Cancer Survivors. 2008; 243: 202–7.
    Google Scholar
14. Rowland JH, Yancik R. Cancer Survivorship: The interface of aging, comorbidity, and quality care. J Natl Cancer Inst. 2006; 988: 504–5.
    Article PubMed Google Scholar
15. Hortobagyi GN. A shortage of oncologists? The American Society of Clinical Oncology. J Clin Oncol. 2007; 2512: 1468–9.
    Article PubMed Google Scholar
16. American College of Physicians. How is a shortage of primary care physicians affecting the quality and cost of medical care? In. Philadelphia; 2008: White Paper.
17. Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol. 2009:JCO.2008.20.3232.
18. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003; 34826: 2635–45.
    Article PubMed Google Scholar
19. Ostbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005; 33: 209–14.
    Article PubMed Google Scholar
20. Smith SM, Allwright A, O’Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management.; 2007. Report No.: CD004910. doi:10.1002/14651858.CD004910.pub2.
21. Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer. 2004; 1018: 1712–9.
    Article PubMed Google Scholar
22. Earle CC, Burstein HJ, Winer EP, Weeks JC. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol. 2003; 218: 1447–51.
    Article PubMed Google Scholar
23. Wu AH, Yu MC, Tseng CC, Stanczyk FZ, Pike MC. Diabetes and risk of breast cancer in asian-american women. Carcinogenesis. 2007; 28: 1561–6.
    Article CAS PubMed Google Scholar
24. Michels KB, Solomon CG, Hu FB, et al. Type 2 diabetes and subsequent incidence of breast cancer in the nurse’s health study. Diabetes Care. 2003; 26: 1752–8.
    Article PubMed Google Scholar
25. Wolf I, Rubinek T. Diabetes mellitus and breast cancer. Diabetes and Cancer. 2008; 19: 97–113.
    Article Google Scholar
26. Report on ambulatory and comprehensive internal medicine: maintenance of certification in internal medicine with focused practice in comprehensive care., 2007. (Accessed May 5, 2009 at http://www.ccimreport.org/report.html)
27. Naderi A, Couch FJ. BRCA2 and pancreatic cancer. Int J Gastrointestinal Cancer. 2007; 31: 99–106.
    Article Google Scholar

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Authors and Affiliations

1. Internal Medicine, Section of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave MC 3051, Chicago, IL, USA
   Susan Hong MD, MPH
2. Harvard Medical School, Boston, MA, USA
   Larissa Nekhlyudov MD, MPH
3. Harvard Vanguard Medical Associates, Boston, MA, USA
   Larissa Nekhlyudov MD, MPH
4. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
   Aarati Didwania MD, MS
5. Internal Medicine Section of Hematology & Oncology, University of Chicago, Chicago, IL, USA
   Olufunmilayo Olopade MD
6. Rush University Medical Center, Chicago, IL, USA
   Pamela Ganschow MD

Authors

1. Susan Hong MD, MPH
2. Larissa Nekhlyudov MD, MPH
3. Aarati Didwania MD, MS
4. Olufunmilayo Olopade MD
5. Pamela Ganschow MD

Corresponding author

Correspondence toSusan Hong MD, MPH.

Appendices

Appendix A: NCI -designated CCC with at least one Adult Survivorship Follow-up Clinic.** [Information Last Accessed from Websites April 1, 2009]

1. * Receives financial support from Lance Armstrong Foundation
2. **Since formal published information on adult survivorship clinics for the 2009 NCI-CCCs is lacking, information was obtained from individual center’s website. Centers had to have a description of a follow-up program on their website that provided individualized follow-up care by a health professional (MD or NP) and provide access to a multidisciplinary team for adult survivors of adult cancers.
3. + General Internal Medicine Involvement Specified at Cancer Center

Appendix B: Types of Cancer Programs in US

1. * Basic science, population, and clinical
2. **Purpose is to expand cancer research and increase access to advanced cancer care
3. ^ http://www.facs.org/cancer
4. » http://accc-cancer.org/

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Hong, S., Nekhlyudov, L., Didwania, A. et al. Cancer Survivorship Care: Exploring the Role of the General Internist.J GEN INTERN MED 24 (Suppl 2), 495–500 (2009). https://doi.org/10.1007/s11606-009-1019-4

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• Published: 18 October 2009
• Issue date: November 2009
• DOI: https://doi.org/10.1007/s11606-009-1019-4

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