Cancer survivorship care has emerged as a critical component of comprehensive oncology treatment, addressing the complex needs of patients from diagnosis through long-term survival. With an unprecedented growth in survivor numbers over the past four decades, healthcare systems are developing evidence-based approaches to support patients' emotional, physical, and practical needs throughout their cancer journey.
The Growing Population of Cancer Survivors
According to Dr. Frank J. Penedo, director of Cancer Survivorship and Supportive Care at Sylvester Comprehensive Cancer Center, there are currently about 20 million cancer survivors in the United States, representing approximately 5% of the population. This number is projected to reach 26-27 million by 2040, driven by advances in early detection and treatment efficacy.
"The National Cancer Institute and the American Cancer Society view an individual as a survivor from the day of diagnosis," explains Dr. Penedo. "Survivorship care is the care that the individual receives after they've completed their primary treatment for cancer."
The majority of cancer survivors are aged 65 years or older, often managing cancer alongside age-related comorbidities such as hypertension, diabetes, and arthritis. This complex health profile creates unique challenges that require specialized care approaches.
Challenges Across the Cancer Care Continuum
Cancer survivors face varying challenges depending on where they are in their journey. At diagnosis, patients typically experience uncertainty, anxiety, and fear, along with information overload regarding treatment options. During treatment, symptom burden becomes significant, with many patients experiencing adverse events that can become chronic and debilitating.
"Role strain associated with being treated for cancer" is another significant challenge, notes Dr. Penedo. "You have to take time off work and your social roles as a mom, a dad, or a caregiver get impacted."
After primary treatment, persistent effects often include fatigue, pain, lymphedema, and cancer-related cognitive impairment, alongside the ongoing surveillance for cancer recurrence or secondary cancers.
These challenges are further complicated by social determinants of health, including financial strain—often referred to as "financial toxicity"—and healthcare disparities affecting minoritized groups, rural communities, and those with fewer financial resources.
Evidence-Based Approaches to Survivorship Care
The University of Miami's Cancer Survivorship and Supportive Care program implements patient-centered care through nuanced assessments addressing psychosocial and physical symptoms resulting from cancer and its treatments.
"We have mechanisms in place to provide social support through groups that address the needs of survivors," Dr. Penedo explains. "We have multidisciplinary services that are embedded within our cancer center that provide services ranging from art and music therapy and massage therapy...to psychology and psychiatric treatment, depending on the severity of the distress that the patient is in."
The program also includes survivorship wellness clinics to prevent fragmentation of care, ensuring patients have an identified primary care provider with access to a survivorship care plan that summarizes treatment, provider team, and care guidelines.
As an NCI-designated cancer center, the program emphasizes evidence-based interventions. "We don't only provide these services like music therapy, acupuncture, or psychosocial care because it's the right thing to do, but [because] we know the evidence in the research literature that these programs can make an impact for our survivors," says Dr. Penedo.
Measurable Benefits of Comprehensive Survivorship Care
Research has demonstrated that systematic assessment and intervention addressing patients' emotional, physical, and practical needs correlates with improved outcomes. Dr. Penedo notes that patients receiving comprehensive survivorship care show "a lower likelihood of having an emergency [department] visit, or being rehospitalized."
"If you're intervening in time...you're able to prevent the patient from decompensating to a level where they get to a clinical episode that requires an emergency [department]," he explains.
Studies have also documented how various interventions—educational, stress management, nutritional, and physical activity—can improve quality of life and reduce symptom burdens like fatigue and depression.
Implementing Survivorship Programs in Clinical Practice
The growing field of dissemination and implementation science is helping translate laboratory research into real-world clinical settings. Programs developed within health systems now deliver evidence-based interventions such as cognitive behavioral therapy and self-management techniques to address quality of life and symptom burden.
Technology plays an increasingly important role, with electronic health records and patient portals helping identify patients with elevated depression or anxiety and delivering evidence-based modules to address these issues.
Partnerships between community clinics and tertiary medical centers or cancer centers are also crucial. "We partner with federally qualified health centers that provide primary care, and we're bringing a lot of the expertise that we have in survivorship to those settings," says Dr. Penedo.
Advice for Community Oncologists
Dr. Penedo emphasizes the importance of creating a comfortable space for patients to discuss survivorship issues, whether treatment-related adverse events or emotional consequences of cancer.
"Trying to normalize that this is part of the experience and the journey of the cancer survivor is really important," he advises. "If [patients] hear from their providers that these issues are important and need to be addressed, that empowers the patient to seek out and receive the necessary services."
While acknowledging that oncologists must prioritize managing the medical condition, Dr. Penedo stresses that factors such as stress, depression, and social determinants of health can significantly impact clinical care. "We look at the patient as a whole, and we understand not only their disease activity and biomarkers of how their cancer is in remission or progressing but also understand the experience of the patient holistically to optimize their outcomes."
As the population ages and cancer rates increase, comprehensive survivorship care will continue to play a vital role in optimizing outcomes and quality of life for the growing population of cancer survivors.
