Phases of Cancer Survivorship Survivorship is a continuum that can be broken down into three phases as shown below. Which phase a survivor belongs to depends on the treatment received, type and stage of cancer, and goal of care as determined by patient and care provider. It is important to note that some survivors of metastatic cancer continue to remain on active treatment for the rest of their lives to keep their cancer under control. Although cancer survivors may face challenges, some groups are at higher risk for severe and long-term and late effects. This includes those diagnosed during childhood, adolescence, and young adulthood (from ages 0 to 39). Several organizations have established guidelines specifically for adolescent and young adult patients including National Comprehensive Cancer Network’s (NCCN) “Adolescents and Young Adults with Cancer” and The Children’s Oncology Group’s “LongTerm Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers.” These guidelines were developed to help standardize and enhance the lifelong follow-up care of individuals who were diagnosed with cancer as children, adolescents, or young adults. For more information, see http://survivorshipguidelines.org/. This also includes older adults (age 65 and older). The NCCN’s “Guidelines for Older Adult Oncology” address specific issues of cancer in older adults, including screening and comprehensive geriatric assessment, treatment risk and benefits, and management of complications from therapies. SIDEBAR 42 Acute Survivorship Extended Survivorship Permanent Survivorship FOCUS Phases DURATION HOW TO COPE Cancer treatment Immediate e ects of cancer and treatment Long-term e ects of cancer and treatment Several weeks Several months Several years • Bone density loss (osteoporosis) • Cachexia and/or sarcopenia • Cognitive impairment (trouble remembering, learning new things, concentrating, and/or making decisions that a ect everyday life) • Diagnosis with a new type of cancer(s) • Distress, anxiety, and/or depression, which can interfere with a person’s ability to cope e ectively with cancer and its treatment • Endocrine dysfunction, which is dysfunction of the collection of organs and glands that control body functions such as growth, sexual development, reproduction, sleep, hunger, and the way the body uses food • Fatigue that is severe and often not relieved by rest • Fear of cancer recurrence • Hearing loss • Heart damage (cardiotoxicity) • Infertility • Insomnia • Joint changes • Lung (pulmonary) damage • Lymphedema, which is swelling, most often in the arms or legs, that can cause pain and problems in functioning • Metabolic syndrome, which occurs when an individual has three or more of the following health risk factors: excess body fat around the waist, high blood pressure, high triglycerides, impaired fasting glucose, and low HDL cholesterol • Nerve problems (including peripheral neuropathy) • Nutrition issues • Oral changes • Pain • Premature aging • Recurrence (return) of original cancer • Sexual dysfunction Time of diagnosis End of Initial Treatment End of Initial Assessment • Build a close circle of support • Manage pain by medication and/or meditation • Adopt a healthy lifestyle • Learn about psycho-oncology and see if it can help you cope with anxiety • Join a cancer support group • Use mindfulness to cope with long-term e ects of cancer treatment • For more information, visit: https://www.cancer.gov/about-cancer/coping CHALLENGES AACR Cancer Progress Report 2023 Supporting Cancer Patients and Survivors 134
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