Advances made in cancer awareness, screening, and treatment have resulted in longer survival after cancer diagnosis. Cancer survivors receiving post-treatment and follow-up face many issues that can adversely affect their lives and the lives of those close to them. Some of these issues include lack of access to ongoing care, denial of health and life insurance coverage, financial hardships, employment problems, and a strain on personal relationships. With over 10 million cancer survivors alive today, and perhaps as many as one million new individuals in the United States joining those ranks each year,¹ the treatment of and support for cancer survivors is becoming increasingly important. 
 

In addition to the increasing number of cancer survivors, the effects of the disease on survivors could be more severe than once thought, affecting both their physical and psychological well-being. One study shows that although most are well adjusted, childhood cancer survivors in early adulthood are more likely to have Post Traumatic Stress Disorder (PTSD) and experience significant impairment compared with healthy peers.² Also, childhood cancer survivors who retain ovarian function after completing cancer treatment are at increased risk of developing premature menopause, possibly leading to an increased risk of osteoporosis, cardiovascular disease, and subclinical atherosclerosis.³* ⁴ Issues that affect screening rates and treatment can also affect the quality of life of cancer survivors, such as income disparities. High-income patients are not only more likely to survive cancer, but they enjoy a better quality of life than low income survivors.⁵  
 

A diagnosis of cancer can also affect survivors longer than previously thought. A recent study in the Journal of the National Cancer Institute found that after seemingly successful treatment, the price of surviving cancer for some people is so high that the risk of attempting suicide, succeeding at it, or having suicidal thoughts remains elevated for decades.⁶  
 

For the last two decades, health care providers and health educators have placed a greater influence on improving cancer survivors’ quality of life through services that address the physical, emotional, social, and vocational challenges of survivorship. The issue of cancer survivorship, however, has yet to be widely recognized as a unique phase of cancer care. While many countries have developed guidelines that specifically address follow-up care, few studies or guidelines address the broader, multifaceted aspects of cancer survivorship.⁷ 
 

Providing appropriate health care to cancer survivors is vital to their quality of life, and should therefore be well-defined. The American Society of Clinical Oncology and the Institute of Medicine recommend that patients completing primary treatment receive a comprehensive summary and follow-up plan written and clearly and effectively explained by the principal provider(s) who coordinated oncology treatment. This plan should consist of  “systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment.”⁸  
 

In addition to prevention of secondary cancers, long-term complications, rehabilitation services, quality-of-life issues, pain and symptom management, and treatment of recurrent cancer, this plan should also address social and occupational concerns of the cancer survivor. For example, a report on cancer survivorship recently released by the Institute of Medicine calls on providers to become familiar with the employment rights of survivors and to offer them information about those rights and programs available to them that can help minimize the adverse effects of cancer on employment. ⁹ 
 

The Utah Department of Health is committed to improving cancer survivors’ quality of life through services that address the physical, emotional, social, and vocational challenges of survivorship. Towards this end, the Utah Cancer Control Program (UCCP) and Utah Cancer Action Network (UCAN) will be holding its annual Utah Cancer Conference on May 3-4, 2007. The conference will focus on the role of the health care provider in helping cancer survivors cope with the physical, social, vocational, and psychological effects of survivorship. The conference will also provide the most up-to-date breast and cervical cancer screening information available. Health care professionals, local health department staff, UCAN members, and other stakeholders in the cancer community are invited to attend. Contact Lynne Nilson at lpnilson@utah.gov or 801-538-7049 for more information. 
 
 
 
 
 
 

¹ Gans, Patricia A. A Teachable Moment for Oncologists: Cancer Survivors, 10 Million Strong and Growing! Journal of Clinical Oncology. Vol. 23, Number 24 (August 20), 2005: pp. 5458-5460.

² Schwartz, Lisa, PhD and Dennis Drotar, PhD. Posttraumatic Stress and Related Impairment in Survivors of Childhood Cancer in Early Adulthood Compared to Healthy Peers. Journal of Pediatric Psychology Vol. 31, Number 4, 2006: pp. 356-366.

³ Green, Daniel H., Catherine Kasper, Ann C. Mertens, Pauline Mitby, Jean Mulder, Stacy Nicholson, Leslie L. Robison, Charles A. Sklar, Marilyn Stovall, John Whitton, and Yutaka Yasui. Premature Menopause in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. Journal of the National Cancer Institute Vol. 98, Number 13, 2006: pp. 890-896.

⁴ Chen, Wendy Y. and JoAnn E. Manson. Premature Ovarian Failure in Cancer Survivors: New Insights, Looming Concerns. Journal of the National Cancer Institute Vol. 98 Number 13, 2006: pp.880-881.

⁵ Mallonee, Erin L. MS, Pamela Farley Short, PhD. Income Disparities in the Quality of Life of Cancer Survivors. Medical Care. 44(1): 16-23, January 2006.

⁶ Twombly, Renee. Decades After Cancer, Suicide Risk Remains High. Journal of the National Cancer Institute Vol. 98, Number 19: pp. 1356-1358. 2006.

⁷ Grunfeld, Eva. Looking Beyond Survival: How Are We Looking at Survivorship. Journal of Clinical Oncology, Vol. 24, Number 32; November 10, 2006: pp. 5166-5169.

⁸ Ganz, Patricia A. and Maria Elizabeth Hewitt (Eds.) From Cancer Patient to Cancer Survivor: Lost In Transition: An American Society of Clinical Oncology and Institute of Medicine Symposium. National Academies Press; 1st edition. March 30, 2006.

⁹ Short, PF. And M.M.Vargo. Responding to employment concerns of cancer survivors. Journal of Clinical Oncology. 10;24 (32):November 2006: 5138-41.