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Feature

Didn’t Know What I Didn’t Know:

Cancer Survivorship

By Thomas Rapisardo, MD, Department of Supportive Oncology, Levine Cancer Institute
S ome of you may have seen an article on cancer
survivorship in USA Today entitled “Life After bypass surgery (another pediatric Hodgkin’s lymphoma survivor). My
Cancer: More Survivors Live Longer, Face New Health career has evolved and now is mainly directed at addressing cancer
survivorship. To say my learning curve has been steep would be an

Challenges.” The article profiled a 71-year-old retired understatement. It was somewhat heartening to hear from a few of the

cancer nurse who had treatment for Hodgkin’s lymphoma in 1972, oncologists that even they have difficulty keeping up. In fact, there is a move

but was only able to get the advice to “try taking a good multivitamin to sub-specialize in specific cancer sections to maintain mastery. Thanks

pill” from her radiation oncologist; he admitted he did not know to major progress in successfully treating cancer, now there are many more

anything else to do to keep the problem from coming back. cancer survivors. The issue is that the very success of cancer treatment has

The woman subsequently developed “three more cancers and heart (thankfully) significantly extended the life and health of patients such that

damage, probably linked to the aggressive radiation and chemotherapy the eventual after-effects of therapy may start exacting a toll.

treatments that helped save her life.” Certainly, things have improved Late-effects of radiation seem to accelerate aging in the

therapeutically since then, but the main point of the article was that exposed tissues, contributing to premature atherosclerosis and skin

just knowing what to expect and what to look for would make a major cancers. Muscle fibrosis may develop in some patients. The lifesaving

contribution to subsequent patient care. chemo cocktails, which include Anthracyclines like doxorubicin/

There is now an actual mandate by the Commission on Cancer Adriamycin or trastuzumab/Herceptin for breast cancer, adversely can

(CoC) to provide Cancer Survivorship Care Plans to patients who have affect cardiac function years after treatments.

completed a course of treatment to usher them into the next stage of their As a primary care internal medicine physician, I found it nearly

life. The first time this got my attention was when one of our pediatric impossible to keep up in all specialties, much less the complexity of

oncologists gave a grand-rounds more than 15-20 years ago profiling cancer care. The information in survivorship care plans is key to care

what long-term issues we could expect to see in adult patients who were continuity and, when absent, hurts the patient and the provider’s ability to

survivors of pediatric cancers and treatments. know what to anticipate for that individual. Thankfully, this movement to

It was timely advice, so I did not dismiss the vague symptoms from a provide a Cancer Survivorship Care Plan document should remedy the

fairly healthy 40ish-year-old woman who subsequently needed coronary problem substantially, if completed with accuracy and completeness.

We can learn a lot from our pediatric oncology

colleagues by following what they have

been doing for decades. For adult patients,

there are protocol-driven evidence-based

guidelines accessible through the National

Comprehensive Cancer Network (NCCN)

or American Society of Clinical Oncology

(ASCO) websites or by contacting Cancer

Survivorship clinics, if geographically

accessible.

The most important guideline

will be from the Cancer

Survivorship Care Plan;

make sure your patients

get one as they move out

of care for their cancer

and back into your care.

The information in survivorship care plans is key to care continuity.

Mailing Address: Center for Supportive Care and Survivorship n 711 E. Morehead St., Charlotte, NC 28202

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