17 hours ago From cancer patient to cancer survivor : lost in transition / Committee on Cancer Survivorship: Improving Care and Quality of Life, National Cancer Policy Board ; Maria Hewitt, Sheldon Greenfield, and Ellen Stovall, editors. p. ; cm. Includes bibliographical references and index. … >> Go To The Portal
Previous IOM reports addressed the needs of childhood cancer survivors (IOM, 2003) and issues concerning care at the end of life (IOM, 1997, 2001b). The committee reviewed the consequences of cancer and its treatment and concluded that they are substantial.
Although the concept of survivorship is not new, we have deter- mined there are times when trends in medical science, health services re- search, and public health awareness converge to forge a new realization. Such may be happening with respect to survivorship research and cancer care with the publication of this report.
Why the expectations of cancer survivors are not being met is not clear, but factors that could be at play include a lack of recognition of the value of these aspects of care, the presence of communication barriers, and a lack of delineation of responsibility on the part of providers to address these con-
These younger uninsured cancer survivors report access to care problems due to concerns about cost—51 percent report delays in obtaining medical care; 44 percent report not getting needed care; and 31 percent report not getting needed prescription medicine.
The problems that cancer survivors face in getting comprehensive andcoordinated care are common to those faced by others with chronic healthconditions. Because cancer is a complex disease and its management in-volves the expertise of many specialists, often practicing in different set-tings, cancer illustrates well the “quality chasm” that exists within the U.S.health care system and the need for health insurance reforms and innova-tions in health care delivery. The committee endorses the conclusions andrecommendations in the IOM report Crossing the Quality Chasm (IOM,2001a). That report provided the rationale and a strategic direction forredesigning the health care delivery system. It concluded that fundamentalreform of health care is needed to ensure that all Americans receive carethat is safe, effective, patient centered, timely, efficient, and equitable.Needed is a health care environment that fosters and rewards improvementby (1) creating an infrastructure to support evidence-based practice, (2)facilitating the use of information technology, (3) aligning payment incen-tives, and (4) preparing the workforce to better serve patients in a world ofexpanding knowledge and rapid change.
The Survivorship Care Plan would inform clinicians involved in thesubsequent care of cancer survivors about treatment exposures and signsand symptoms of late effects, and, in some cases, would provide concretesteps to be taken. To carry out this plan, an organized set of clinical practiceguidelines based on the best available evidence is needed to help ensureappropriate follow-up care. Some guidelines are available for certain as-pects of survivorship care, but most are incomplete. Such guidelines wouldprovide specific information on how to manage the complex issues facingsurvivors of adult cancers. Assessment tools and screening instruments forcommon late effects are also needed to help identify cancer survivors whohave, or who are at high risk for, late effects and who may need extrasurveillance or interventions.