The substantially increasing number of cancer survivors in Europe led the EU Joint Action on Cancer Control (CanCon) to focus on survivorship and rehabilitation as part of the European guide on quality improvement in comprehensive cancer control.1 The objective was to take into account the psychosocial needs of patients and improve quality of life (QOL) for cancer patients through support, rehabilitation and palliative care.2 A patient-centred approach is of paramount importance in planning care provision for cancer survivors and ensuring optimal QOL. The quality of care for cancer survivors is impaired if there is poor coordination, if communication is lacking, or if there is uncertainty about the key contact person in follow-up. This can result in poorer psychosocial outcomes and unmet needs. The report identified the importance of the advice from the US Institute of Medicine that specific templates should be developed for the follow-up of cancer survivors and used in the development of survivorship care plans to overcome the many factors impeding good QOL for cancer survivors.3 It is clear, however, that such care plans are still used to only a modest degree because of the difficulty of integrating them into practice and the resources required to do so. The improvements in cancer survival that we are observing reflect in part the increasing scale and quality of clinical cancer research and trials. The European Organisation for Research and Treatment of Cancer has responded to this challenge by highlighting the importance of survivorship and addressing this need through research and innovation.4
Key areas for recommendations
The main messages of the EU CanCon initiative for survivorship and rehabilitation are shown in Table 9.1. In describing cancer survivorship, CanCon drew on the definition provided by the US National Coalition for Cancer Survivorship (www.canceradvocacy.org) which describes it as 'the experience of living with, through and beyond a diagnosis of cancer'. This inclusive definition means that a cancer survivor is anyone who has had a diagnosis of cancer and who is still alive. This includes individuals receiving treatment with curative, life-prolonging or palliative intent, as well as those in follow-up.3,5,6 The best approaches employ survivorship care plans that cover both medical and non-medical aspects of care. Models reported include the shared care model and the availability of specialized survivorship clinics,7 as well as collaboration between primary and hospital care. Care plans need to establish how responsibility should be shared. Evidence suggests that there is considerable added value for patients and healthcare systems with the use of survivorship care plans even though they are currently far from routine.
Table 9.1Survivorship and rehabilitation: main messages from the CanCon project.1 |Favorite Table|Download (.pdf) Table 9.1 Survivorship and rehabilitation: main messages from the CanCon project.1
|•Cancer survivors' follow-up, late effects management and tertiary prevention ...|