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As the cancer survivor population has continued to grow, so too has the amount of research directed toward helping these 12 million people in the United States and their counterparts worldwide lead better, longer lives.

Much of that research and the key concerns of survivors were highlighted during the fifth Biennial Cancer Survivorship Research Conference: Recovery and Beyond, held June 17–19, 2010, in Washington, DC. Cosponsors included the National Cancer Institute (Nd), the American Cancer Society, LIVESTRONG, and the Centers for Disease Control and Prevention.

The Benefits of Physical Activity and Weight Loss

  1. Top of page
  2. The Benefits of Physical Activity and Weight Loss
  3. Cancer Rehabilitation
  4. The Value of Follow-up Care
  5. Reference

Three key themes emerged from the conference, according to Catherine Alfano, PhD, program director and behavioral scientist with the NCI Office of Cancer Survivorship. The first theme was growing evidence in the areas of physical activity, weight status, and survivorship.

“We have seen that poor physical activity and weight problems can lead to [things] like lymphedema, fatigue, and sleep problems, but there also have been several large cohort studies that show they also can affect survival,” Dr. Alfano notes.

What's needed next is a randomized, controlled study determines whether weight loss has a positive effect survival. Determining whether that's the case would be helpful because “survivors want to take back the reins of control—they want to do something that impacts their quality of life and prognosis,” she says.

Several studies presented at the conference looked at methods of changing participants' behavior, such as whether mothers exercising with daughters or men exercising with their spouses actually help with motivation Although the former was not always found to be effective, latter seemed to work well, Dr. Alfano noted.

Kathryn Schmitz, PhD, MPH, of the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania, talked about the importance of taking such exercise and wellness programs into the community. Most survivors want to go someplace “normal” and be like everyone else rather than return to the hospital where they were treated cancer, Dr. Schmitz observes.

With that knowledge in mind, LIVESTRONG began working jointly with the YMCA in 2007 to launch a “LIVE-STRONG at the YMCA” program for cancer survivors, with goal of helping cancer patients and survivors reach their health and fitness goals. The collaboration began in cities across the country with plans to increase that number to at least 150 YMCA5 nationwide.

Cancer Rehabilitation

  1. Top of page
  2. The Benefits of Physical Activity and Weight Loss
  3. Cancer Rehabilitation
  4. The Value of Follow-up Care
  5. Reference

A second theme that came out of the conference was the need for comprehensive approaches to cancer rehabilitation and recovery. Cancer rehabilitation is a “new old idea” that received a lot of attention in the past but fell out of favor. Now leaders in the field are trying to reintroduce the concept.

The goal is to focus on the “whole patient”—to help patients lead active lives and be able to fulfill all of their life roles, be it parent, employee, spouse, or something else. Most cancer hospitals do not have these types of intensive rehabilitation programs, nor are they required to do so as NCI Comprehensive Cancer Centers. Some of the exceptions include the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, Duke University, and Case Western Reserve University, according to Dr. Alfano, who notes that funding and insurance reimbursement are clear barriers.

Insurance companies must begin to recognize that a coordinated, comprehensive approach to rehabilitation is more cost effective, so conference presenters put out a “call to action” for more research in this area.

One of the presenters, Andrea Cheville, MD, associate professor of medicine and rehabilitation at the Mayo Clinic in Rochester, Minnesota, called attention to the need for more research into how musculoskeletal issues, pain, fatigue, lymphedema, psychological distress, and sexual dysfunction interact to create disablement among breast cancer survivors. These survivors make up the largest group of all cancer survivors nationwide—23%—Dr. Cheville noted.

The general belief is that most breast cancer survivors do fairly well after treatment, but Dr. Cheville found that about 15% of them have major disabilities that interfere with their ability to lead normal lives.

The time to start interventions to prevent disability is during treatment, but the current state of science does not provide guidance on how to do so, she notes. Some interventions include early physical therapy, which has been shown to reduce lymphedema, pain, and shoulder problems. For that reason, all breast cancer patients should be referred to a physical therapist for at least one visit for education and empowerment to understand what's normal in their recovery. Community-based physical therapists also need training in recognizing the needs of breast cancer patients, she adds.

Dr. Cheville's work also focuses on sensitive ways to screen survivors for disabilities. Because both oncologists patients are focused primarily on recurrence, functional issues often take a back seat, she notes, adding that screening option is to use “patient self-report” —a series of questions used to screen for functional, emotional, pain, and fatigue problems. If patients can complete this of telephone survey in advance of their doctor's appointments, clinicians can be better prepared.

The Value of Follow-up Care

  1. Top of page
  2. The Benefits of Physical Activity and Weight Loss
  3. Cancer Rehabilitation
  4. The Value of Follow-up Care
  5. Reference

A third theme at the conference was follow-up care for patients who have completed their cancer treatment. Often, these survivors do not know which doctor to see, what type of tests they need in the future, and how often they need to get them.Whether they should continuing seeing their oncologist or switch to their internist is the subject of current debate.”Maybe there should be a hybridized survivor clinic—which doesn't exist now,” Dr.Alfano says.

An Institute of Medicine report concluded that upon completion of treatment, all cancer patients should receive treatment summaries and a follow-up care plan that is holistic in nature—going into detail on issues such as mental health and physical fitness as opposed to just recommending repeat mammograms, for example.1 At the moment, however, different cancer centers implement those plans in different ways.

As a result, the Office of Cancer Survivorship plans to hold a meeting in 2011 to discuss ways to build evidence elements that should be included in a standard follow-up care plan. Breast cancer follow-up, for example, is well researched, but other cancers do not have definitive recommendations for frequency of monitoring and future care.

Reference

  1. Top of page
  2. The Benefits of Physical Activity and Weight Loss
  3. Cancer Rehabilitation
  4. The Value of Follow-up Care
  5. Reference
  • 1
    HewittM, GanzP, eds Implementing Cancer Survivorship Care Planning. Washington, DC: The National Academies Press; 2006.