Identifying key questions to advance research and practice in cancer survivorship follow-up care: a report from the ASPO Survivorship Interest Group.
Identifying key questions to advance research and practice in cancer survivorship follow-up care: a report from the ASPO Survivorship Interest Group.
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DOI：
10.1158/1055-9965.epi-18-7-aspo01
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发表时间：
2009-07-01
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影响因子：
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通讯作者：
Buist, Diana S M
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作者：
Hudson, Shawna V;Chubak, Jessica;Buist, Diana S M
癌症幸存者包括癌症的身体、社会心理和经济后果，包括与保健和后续治疗、治疗的后期影响、原发癌症复发监测、第二原发癌症筛查和生活质量有关的问题。几乎三分之二被诊断患有癌症的人预计至少能存活5年。对于某些癌症，如乳腺癌和前列腺癌，5年生存率超过88%(1)。越来越多的癌症幸存者和越来越高的癌症发病率(2)令人担忧，这将导致美国医疗保健系统无法应对的肿瘤服务挑战。美国临床肿瘤学会（ASCO）预测，到2020年，医学肿瘤学家将出现短缺，这将需要一个多方面的战略，以满足未来的肿瘤学和癌症后续护理需求(3)。幸存者随访护理比癌症复发监测更重要（4,5）。医学研究所（IOM）的报告《从癌症患者到癌症幸存者：迷失在过渡时期》(5)和越来越多的研究人员将护理的连续性（6-9）和护理协调（10）描述为实现更好的幸存者护理的最重要因素。根据国际移民组织的报告，全面的后续护理包括：(i)预防和检测新的和复发的癌症；（ii）监测癌症扩散、复发或第二次癌症；（iii）干预治疗的后期和长期影响；（四）专家和初级保健医生之间的协调，以满足幸存者持续的保健需求。在2009年美国预防肿瘤学会（ASPO）年会上，生存兴趣小组（SIG）提出了一些重要的问题，以推进与后续护理相关的癌症生存研究和实践。对于研究人员和临床医生来说，这是一个不断发展的研究领域。与ASPO SIG之前的会议类似，该小组断言，癌症相关的后续护理需要跨研究和基于实践的组织的跨学科合作（12）。这种合作需要建立一个强有力的证据基础，为干预措施的设计提供信息，帮助提供者和幸存者更有效地管理癌症相关的后续护理。此外，ASPO SIG关注的是狭义定义的幸存者后续护理之间的紧张关系，即解决幸存者的癌症预防和监测需求，而不是在更广泛的健康促进背景下检查这些问题，以及管理治疗的晚期和长期影响以及其他共病条件的竞争需求。论坛讨论的问题包括：(i)护理的重新设计，（ii）评估新护理模式有效性的重要性，以及（iii）患者在后续护理中的作用。本报告的目的是总结该小组的主要讨论点，以便向癌症预防和控制研究人员、初级保健和肿瘤学专业人员传播，并使幸存者倡导者和其他专业组织参与围绕这一主题的对话。
Cancer survivorship encompasses the physical, psychosocial, and economic consequences of cancer, including issues related to health care and follow-up treatment, late effects of treatment, surveillance for recurrence of the primary, screening for second primary cancers, and quality of life. Almost two-thirds of individuals diagnosed with cancer are expected to survive for at least 5 years. For some cancers, such as breast and prostate, 5-year survival rates exceed 88%(1). There is concern that the increasing numbers of cancer survivors combined with greater cancer incidence (2) will result in an oncologic service challenge that the US health care system is ill-equipped to handle. The American Society of Clinical Oncology (ASCO) projects a medical oncologist shortage by 2020 that will necessitate a multifaceted strategy in order to meet future oncology and cancer follow-up care demands (3). Survivor follow-up care is more than surveillance for recurrence of cancer (4, 5). The Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lost in Transition (5), and a growing number of researchers, describe continuity of care (6-9) and care coordination (10) as paramount for achieving better survivor care. According to the IOM report, comprehensive follow-up care incorporates:(i) prevention and detection of new and recurrent cancers;(ii) surveillance for cancer spread, recurrence or second cancer;(iii) intervention for late and long-term effects of treatment; and,(iv) coordination between specialists and primary care physicians to meet survivors’ ongoing health care needs (v). At the 2009 annual meeting of the American Society of Preventive Oncology (ASPO)(11), the Survivorship Interest Group (SIG) raised questions important to advancing cancer survivorship research and practice related to follow-up care. This is a developing area of inquiry for researchers and clinicians. Similar to previous meetings of the ASPO SIG, the group asserted that cancer-related follow-up care requires transdisciplinary collaborations across research and practice-based organizations (12). Such collaborations are required to build a strong evidence base to inform design of interventions that can help providers and survivors more effectively manage cancer related follow-up care. In addition, the ASPO SIG focused on the tension between narrowly defining survivorship follow-up care as addressing the cancer prevention and surveillance needs of survivors versus examining those issues within the broader context of health promotion and competing demands of managing both late and long-term effects of treatment and other co-morbid conditions. Issues addressed in the forum included:(i) care redesign,(ii) the importance of evaluating the effectiveness of new models of care, and (iii) the role of patients in their follow-up care. The purpose of this report is to summarize the group’s key discussion points for dissemination to cancer prevention and control researchers, primary care and oncology professionals, and to engage survivor advocates and other professional organizations in dialogue around this topic.