Cancer study urges more follow-up care

WASHINGTON – The nation’s 10 million cancer survivors require customized follow-up for years that too few now receive, says a major study that calls for oncologists to create a “survivorship plan” to guide every patient’s future health care.

Half of all men and one-third of women in the United States will develop cancer in their lifetimes. Thanks to advances in early detection and treatment, the number who survive has more than tripled over the past three decades.

When active treatment ends, these people’s special needs may be just beginning, said the study, released Monday. Yet the legacy of physical, psychological and social consequences has largely been ignored by doctors, researchers, even patient-advocacy groups, leaving survivors too often unaware of simmering health risks or struggling to manage them on their own, said the report by the Institute of Medicine.

“There is currently no organized system to link oncology care to primary care,” explained Dr. Sheldon Greenfield of the University of California, Irvine, who led the study for the institute, an arm of the National Academy of Sciences.

Survivors are at risk of their initial cancer returning or a new one forming. Then there are the lingering health effects that various cancer treatments can cause: problems with mobility or memory, nerve damage, sexual dysfunction or infertility and impaired organ function. There may be distress over cosmetic changes. Other hurdles include keeping health insurance and discrimination from employers.

Monday’s recommendations by the Institute of Medicine, chartered by Congress to advise the government on medical matters, is sure to add momentum to still-fledgling efforts at survivor care. Among the recommendations:

•Every patient completing cancer treatment should be given a customized “survivorship care plan” to guide future health care.

•That plan should summarize their cancer care down to drug and radiation dosages, cite guidelines for detecting recurrence or new malignancies, and explain long-term consequences of their cancer treatment. It also should discuss prevention of future cancer, and cite the availability of local psychosocial services and legal protections regarding employment and insurance.

•Specialists and primary care providers should coordinate to ensure survivors’ needs are met.

•Health insurers should pay for this report.

•Scientists must improve, or in some case create, guidelines on exactly what screenings are needed for different cancers and their therapies.