Specific survivor populations have unique needs
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Quality survivorship care should consider the unique needs of specific patient populations, according to a session during the virtual Cancer Center Survivorship Research Forum.
“The survivorship forum is focused on the common experience of cancer, but we also know that each person experiences cancer completely differently,” session moderator Lucie Turcotte, MD, MPH, MS, assistant professor of pediatrics in the division of hematology/oncology at the University of Minnesota, said in an interview with Healio prior to the presentation. “This session is going to get into some of those specific needs of our different populations. We’ll discuss how we can take this shared experience of cancer survivorship and focus it for each of these unique populations.”
Survivors of pediatric cancers often have many years of survivorship ahead of them and, therefore, have distinct needs in terms of long-term care. In her presentation, Tara O. Henderson, MD, MPH, professor of pediatrics at the University of Chicago, discussed the issues this population faces throughout their lifetimes. “Childhood and AYA cancer survivors are a group with significant rates of chronic health conditions,” Henderson said. “Many survivors are not receiving the risk-based care that has been recommended. Once we get effective interventions, we need to think about disseminating our guidelines to make sure patients are getting the care they need.”
In her presentation, Supriya Mohile, MD, MS, professor of medicine and surgery at the University of Rochester, discussed the needs of older adults, who comprise a large percentage of individuals with cancer and are underrepresented in clinical trials.
“The percentage of older adults enrolled in standard clinical trials should reflect the percentage of patients in the general population,” Mohile said. “We need to better understand how cancer and treatment interact with vulnerabilities, which impact understanding of safety and efficacy of interventions.”
Another previously underrepresented population of survivors is sexual minorities, who embark on cancer treatment and survivorship with distinct needs and preferences. Presenter B.R. Simon Rosser, PhD, MPH, LP, professor in the division of epidemiology and community health at the University of Minnesota, discussed an NCI-funded study he is leading, which is the first study to evaluate gay and bisexual men with prostate cancer.
“Cancer in sexual minorities is very under-researched. The sexual and gender minority population has been invisible because most cancer centers do not collect information about sexual orientation,” Rosser said. “It’s not easy being invisible, but what we have learned as members of the LGBTQ population is that what we don’t know can and will kill us.”
Turcotte discussed how Rosser’s research has highlighted the possible differences in treatment preferences between gay and straight patients.
Access to quality care is an ongoing challenge in survivorship, and this is especially true of patients who live in rural areas. In these areas, which frequently do not have nearby academic medical centers, survivorship programs may be scarce or nonexistent. In her presentation, Smita Bhatia, MD, PhD, addressed urban vs. rural residence mortality differences among older patients with breast cancer, noting that these are highly predicted by poverty level. She discussed the possibility of loan-repayment programs for rural patients and survivors, as well as “hub and spoke” care delivery models.
“These are some of the possibilities for improving the delivery of care for rural cancer survivors,” she said.
The last presentation, made by Shawna Hudson, PhD, of Rutgers Robert Wood Johnson Medical School, emphasized the various effective strategies that exist to address the needs of marginalized populations.
“I want to say that while we have unique populations with very complex needs, we also have approaches that allow us to think through what the pathways need to look like for those groups,” Hudson said. “We need to look at ways to personalize medicine, but we need to do it in a way that allows our patients to be part of the problem-solving process.”
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Turcotte L, et al. Personalizing care for unique populations. Presented at: Cancer Center Survivorship Research Forum (virtual meeting); April 15-16, 2021.
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