Improving the Post-Treatment Experience of Cancer Survivors

Randall Oyer, MD

Oncology care does not end when a patient’s treatment ends, according to Randall Oyer, MD. Patients who survive cancer experience treatment-related adverse reactions that can follow them for years after treatment. Addressing the needs of these patients requires multidisciplinary and multi-sector action.

In a paper published in the Journal of the National Cancer Institute, investigators including Oyer, medical director, Ann B. Barshinger Cancer Institute, Lancaster General Hospital provided recommendations for improving patients experiences after cancer treatment. The recommendation covered changes in practice, data collection and oversight, clinical trials, and policies to reduce adverse consequences.¹

“In November of 2020, the National Cancer Policy Forum and the Center for Aging, Disability and Independence convened a workshop to address the adverse consequences of cancer treatment. We talked about the high priority areas, which included 3 adverse effects from treatments themselves, on the heart, the lungs, bones, muscles, and emotional effects, the potential for several cancers, particularly in our pediatric cancer survivors, and financial toxicity, all due to cancer treatment,” Oyer told Targeted Oncology^TM, in an interview.

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Oyer et al consider focusing on these high-priority problems to be the key to reducing the negative impact of cancer treatment-related adverse reactions.

In the interview, Oyer explained the purpose behind the National Cancer Policy Forum and the Center for Aging, Disability and Independence workshop, and the cancer care and primary care recommendations that were born from it.

TARGETED ONCOLOGY: Can you provide an overview of your research?

Oyer: We’ve 've made a lot of progress in cancer, and at this point, we have 17 million cancer survivors in the United States. By 2030, we expect to have 20 million cancer survivors in the United States. Many of these people are cured of cancer, but are also living with adverse consequences of their cancer treatment.

In November of 2020, the National Cancer Policy Forum and the Center for Aging, disability and independence convened a workshop to address the adverse consequences of cancer treatment. We talked about the high priority areas, which include 3 adverse effects from treatments themselves, on the heart, the lungs, bones, muscles, and emotional effects, the potential for 7 cancers, particularly in our pediatric cancer survivors, and financial toxicity, all due to cancer treatment.

Can you explain the findings?

One of the major findings is that the entire area is that is quite complex. It would require a large collaborative team to address all the issues. It requires medical oncologists, radiation oncologists, surgical oncologists, but also our specialty partners, and importantly, a person's primary care physician. We know that cancer survivors face the same problems that everyone else does. Primary care physicians, not oncologists, are the best ones to manage hypertension, high cholesterol, and glucose. Additionally, in every community, we need a large component of services to support people in their recovery. Things like physical therapy, exercise, nutrition, counseling, and spiritual support, need to be added. It will take a big team.

We also provided recommendations for this approach. One is that we need to standardize care. To standardize care, we need to be doing a pretreatment assessment of our patients to understand who might be more susceptible to what type of complication who needs extra support to get through their treatment. Secondly, we have to plan ahead with rehab and other services introduced very early on. Thirdly, we need to collect standardized data and set up a research agenda so that we can study these problems.

Each patient and each problem might be small or unique in each setting or each cancer center, but altogether, many people across the United States are treated with the same drugs and have the same complications. Together we need to form a large database, which is the beginning our ability to study, ask questions, and come up with answers to help our patients. We also looked at some policy opportunities. One would be to make sure that medical care and medical insurance continued for the adverse effects of treatment. If that were possible, employers would allow time off or paid time for treating not just the cancer, but the long-term side effects and may interfere with a person's function later on.

What recommendations do you have for the oncology field based on your study?

I think that we need to talk with our patients about the benefits, as well as the consequences of treatment. We need to individualize something for the person we're talking with, we need to communicate well with our primary care colleagues to let them know when a patient's cancer is in remission, what the potential adverse effects of the treatment, which honestly should be a shared responsibility between the medical oncologist and the primary care, and then let them know it's safe to take the patient back into their good and caring hands. The primary care will then handle the management of hypertension, high glucose, high cholesterol just as they would anybody else.

_REFERENCE:

_{Bradley CJ, Kitchen S, Bhatia S, et al. Policies and practices to address cancer’s long-term adverse consequences. J Natl Cancer Inst. 2022;114(8):1065-1071. doi:10.1093/jnci/djac086.}