Aziz NMCancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol 46: 417-432

Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892, USA.
Acta Oncologica (Impact Factor: 3). 02/2007; 46(4):417-32. DOI: 10.1080/02841860701367878
Source: PubMed


Seminal advances in early detection of and treatment strategies for cancer have led to burgeoning numbers of cancer survivors. While most therapeutic modalities for cancer are beneficial and lifesaving, they are associated with adverse long-term and late sequelae.
Literature review using MEDLINE to identify studies examining adverse medical outcomes and post-treatment follow-up care among long-term survivors. Emerging concepts in survivorship research such as definitional issues, research paradigms and methodologic concerns were also examined.
Long-term or late adverse sequelae are more prevalent, serious, and persistent than expected in survivors of pediatric and adult cancer, but remain understudied especially among those diagnosed as adults. Follow-up care relevant to survivorship outcomes is neither standardized nor guideline or evidence based for most adult cancers, and optimal practices have yet to be defined.
Adverse sequelae contribute to burden of illness, health care costs, and decreased length and quality of survival. To-date, very few studies have compared survivor outcomes pre-and post diagnosis. It is critical to examine under-researched questions and understudied survivor groups. Regular follow-up care and monitoring of health status post cancer treatment should 1) permit the timely diagnosis and treatment of adverse outcomes; 2) enable timely diagnosis and treatment of recurrences; 3) facilitate screening and early detection of second cancer(s); 4) allow for detection and management of co-morbidities; and 5) provide the opportunity for preventive strategies such as lifestyle changes. Research findings to-date underscore the need for continued cancer survivorship research that will: inform our understanding of the mechanisms underlying adverse sequelae; lead to the design of less toxic treatments; test the effectiveness of interventions - medical, pharmacologic, and behavioral - that reduce adverse outcomes; test models of post-treatment follow-up care; develop an evidence base for optimal follow-up care practices; and inform survivor and provider decision making.

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Available from: Noreen Aziz, Dec 15, 2015
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    • "In general, health care providers have focused largely on patients' physical symptoms and physical health status, and less emphasis has been placed on mental health issues[7]. Physical symptoms vary across cancer types and treatment modalities but commonly include fatigue, sleep disturbances, pain, nausea and/or vomiting, diarrhea, neuropathy, skin rashes or toxicity, cachexia, arthralgias, myalgias, lymphedema , impaired sexual functioning, and cognitive problems[5,6]. How these symptoms impact quality of life varies depending on a number of factors, including the type and stage of cancer at diagnosis, the patient's prognosis, the type of treatments received, the patient's age, and comorbidities (both before and after the cancer diagnosis). "

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    • "Since the 1970s, the death rates of women with gynecological cancer have significantly declined. As a result, there have been a growing number of survivors who are forced to cope with the consequences of the disease and its treatments (Aziz, 2007). Although survivorship is considered the most important outcome of a gynaecological cancer experience, it is understudied, and thus, the least understood aspect of the disease (Holland & Reznik, 2005). "
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    ABSTRACT: The purpose of this study was to understand the lived survivorship experience of Portuguese women with gynaecological cancer. A phenomenological hermeneutical method, inspired by Ricoeur’ theory of interpretation was employed. Ten women cancer survivors were recruited. An iterative process was carried out to identify themes and interwoven them into the four existentials of life world to lend structural meaning to the lived experience. Female survivors reported stories of positive and negative change complete with doubts and fears, as well as renewed relationships and altered priorities. Assisting clients with finding their ‘new normal’ and embracing its possibilities is critical to their long-term success.
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    • ", 2006 ) . As sub - optimal language skills may reduce survivor quality of life for the individual ( Murdoch , 2011 ) and increase the burden of illness for the wider community ( Aziz , 2007 ) , it is timely , there - fore , to investigate the language outcomes of children treated with contemporary posterior PFT treatment pro - tocols to determine the rehabilitative needs following the provision of medical care . Pre - morbid language and / or neurocognitive perfor - mance indices of children presenting with PFT are rarely available , and when available , may not be a reli - able reflection of capabilities due to mass effects of the tumor . "
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    ABSTRACT: Up to 85% of children treated for brain tumor survive beyond five years; hence optimizing quality of life in survivorship has become a priority. As multiple factors contribute to the heterogeneity of neurocognitive and language outcomes for individual children following treatment, a means of monitoring subsequent development is needed for the individual child, particularly when pre-morbid performance indices are not available. The current study investigated the use of developmental language trajectories as a means of monitoring language development subsequent to treatment for tumors located within the posterior fossa. The language skills of four children treated for posterior fossa tumor (PFT) were monitored over time (range of monitoring: 2-6 years) and the resultant trajectories were plotted against the trajectories based on tests' normative data as well as the trajectories of control children drawn from each child's local community. Each child's trajectory was considered in terms of age-appropriate developmental gains and discussed regarding the need for ongoing clinical monitoring of emerging, developing or established language skills. The study's findings highlight the heterogeneity of language outcomes following PFT. The utility of the application of developmental trajectories for the provision of individualized post-treatment support is discussed.
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