Importance of addressing cancer survivorship care in light of Kate Middleton’s news
Key takeaways:
- More survivors are living long lives with cancer sequelae.
- Survivorship care is not a “one-size-fits-all” approach and is ever-changing.
Physicians often experience increased interest and comfortability in patients broaching a health topic once a celebrity talks about it openly in the public eye.
Princess Kate Middleton recently going public about her cancer remission and experiencing late adverse events from treatment is no exception.
Healio spoke with Marleen Meyers, MD — clinical professor of medicine at NYU Langone and director of the Perlmutter Cancer Center Survivorship Program — about the importance of survivorship care and how to respond to some of the most common questions oncologists may receive amid the announcement.
Healio: Why is survivorship care so important along the cancer care trajectory?
Meyers: Years ago, we, as oncologists, would be happy if someone was cured of their cancer — even if they were left with cancer sequelae. It was not something that we readily addressed because we were so happy that they were cured, and we often didn’t think past that.
As more and more cancer survivors are living long lives with the side effects of treatment — both physical and emotional — it has become paramount to address this issue.
A patient is a survivor from the moment of diagnosis, and we think of their friends and families as survivors too, because they are part of their trajectory going forward.
The significance of survivorship care is that we are curing more people — even people that we don’t cure are living much, much longer — so it’s important that we address their quality of life. It’s not enough just to survive cancer, but we need to address how people are living and thriving with cancer or with a history of cancer.
Healio: How can our readers respond to questions that may be rolling in after Princess Kate’s announcement about experiencing adverse events from treatment?
Meyers: Princess Kate was certainly very gracious about letting people know that she had cancer and is in remission, but we still don’t know what cancer she had, what remission means to her or what treatment she had. Therefore, we don't know what her side effects are or what her survival is. Other than her being a survivor, in her own words, we really don’t have much information.
When my patients ask me questions about that, that is exactly what I tell them. The important thing to remember is, regardless of what the Princess’s cancer was or what treatment she received, it is important to remember that survivorship is very individualized, not only by type of cancer, but also by who the person is, what other comorbidities they may have and what side effects they have suffered from treatment. We can all be happy for Princess Kate’s announcement, but it doesn’t inform us in terms of what to tell our patients or what to tell anyone that may have questions.
The other important issue is that there are a lot of different terms that are used at the completion of cancer treatment — remission is one, but so are terms like “cancer free” or “no evidence of disease” vs. “cure.” When we say that someone is cured of cancer, the expectation is that it won’t come back. When we say that someone is “in remission” or is “free of cancer” or has “no evidence of disease,” that means that clinically, we don’t see any evidence of cancer, whether on scan or physical exam or blood test, but it doesn’t mean that the cancer will never come back.
Healio: Can you offer key advice for physicians about speaking with their patients about weighing the risks and benefits of cancer treatment?
Meyers: The most important advice is that we must be very granular when speaking with patients so that they know our expectations of treatment. For example, is the treatment being given for curative intent or is it being given more so for a palliative effect.
When a patient is undergoing treatment with curative intent, they are much more likely to put up with side effects that may be more disturbing or disabling, whereas someone who is not treated for curative intent, quality-of-life issues become more important.
The risks of treatment are extremely important to discuss, because everyone has their preferences for how they want to live their life. There may be side effects of treatment that may be displeasing or uncomfortable but are expected to go away. There also can be potential risks of treatment that can be permanent, such as cardiac disease or permanent damage to the endocrine system. It is important to give patients a thorough understanding of what the side effects are of treatment.
Healio: Should survivorship care be lifelong for all patients? Why or why not?
Meyers: We have to think of survivorship care as lifelong, but the important thing is that survivorship care is not a “one-size-fits-all” issue.
How long someone is treated or thought of as a survivor very much depends on the cancer they had and what the treatment is. Many people, after a certain number of years, can stop seeing their oncologist regularly and can receive their care with their primary care doctor. But that requires that the primary care doctor be open to that and be aware of potential recurrences, because, unfortunately, when someone has a history of cancer, they have to consider recurrence in the diagnosis.
Healio: What advice can you offer the younger generation of physicians who may be interested in focusing on survivorship care?
Meyers: I would advise the younger generation to keep in mind that survivorship care is ever changing as our dreams are changing. If we go back 20 years, before we had a lot of the new drugs that we have now, the expectations for side effects were quite different than what we have now with immunotherapy and targeted therapy.
Survivorship care is something that is continuously evolving.
I would also say that we have to start thinking in a different way about considering patients with stage IV or better metastatic cancer as survivors as well, because for many cancers, such as breast or lung, people can live with stage IV disease for many years. We have to address quality-of-life issues, and we very much have to address the psychosocial issues of this because living with stage IV cancer and knowing that it’s potentially not curable and that they will be on treatment their whole life has a significant psychosocial impact.
Healio: Do you have anything else that you'd like to mention?
Meyers: Two important things. One is that there is no right or wrong way to do survivorship care. Some institutions may have survivorship clinics, some may offer this type of care within each practice. There is not a “best” way, or “right” or “wrong” way, but rather being aware that we have to address issues that our cancer survivors have.
The second important thing is that survivorship care is highly individual. Some people may have nothing in the way of cardiac issues. Other people may have much more profound psychosocial issues, such as depression, anxiety and/or fear of recurrence, whereas other people may not experience any of this. It’s about knowing your patients and asking them what you can do for them and what their needs are at this moment, and it is important to know that those needs can change throughout the trajectory of their treatment.
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