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Keywords:

  • cancer survivorship;
  • international cooperation

Abstract

  1. Top of page
  2. Abstract
  3. FUNDING SUPPORT
  4. CONFLICT OF INTEREST DISCLOSURES
  5. REFERENCES

The authors describe the rationale and background of the present supplement to Cancer intended to stimulate a dialogue among researchers from Europe and North America regarding important issues faced by cancer survivors. Through jointly written articles addressing various aspects of cancer survivorship, each manuscript reports on the similarities, disparities, and problems viewed from the point of view of each author's respective continent. The supplement is meant to create a springboard for increased collaboration and aid in the development of a shared care model to improve the quality of cancer care, both during and after the completion of primary treatment. We hope that this effort may represent a new model of international cooperation, which is fruitful not only for the field of scientific research but also for identifying and sharing new approaches to the care and management of cancer survivorship issues, ultimately bringing improvements to quality of life of the growing population of cancer survivors. Cancer 2013;119(11 suppl):2083-5. © 2013 American Cancer Society.

The considerable progress in cancer care occurring over the past few decades in surgery, chemotherapy, radiotherapy, and adjuvant therapies and our ever-growing knowledge base in all areas along the cancer research continuum have undoubtedly led to greatly improved clinical outcomes. However, the growing number of individuals surviving cancer, and the facility with which modern technology allows us to communicate our thoughts, feelings, and experiences, has also meant that we have stopped viewing cancer in a purely clinical sense and have begun to develop an awareness of the human being behind the disease. More often than not, those who receive a diagnosis of cancer now no longer ask themselves how long they have to live, but rather how well they can expect to live from that moment onward. This shift in thinking from “cancer survival” to “cancer survivorship” has led to a notable increase in research on “life beyond cancer” in recent years.

This research has indicated that a significant percentage of cancer survivors experience negative physical, social, and emotional effects as the result of their cancer and its treatment. Some of these effects may present initially or during or shortly after treatment and linger in a persistent manner whereas others may develop months or even years after the completion of treatment (late effects). Regardless of their time of onset, these effects may negatively impact the quality of life of cancer survivors. Yet despite the growing body of scientific literature on cancer survivorship, many questions remain regarding how to assess, treat, and prevent survivorship-related problems. Indeed, the complex array of potential risks, problems, and long-term effects cancer survivors face and the methods to control them are just beginning to be explored and understood. Moreover, the degree to which these issues are becoming recognized varies greatly both across and within international geographic regions. Some countries are quite advanced with respect to the awareness and management of survivorship issues whereas others are just beginning to recognize and address the unique problems and concerns that cancer survivors face after the completion of their primary adjuvant treatment. Even in countries with more advanced approaches, there are few evidence-based recommendations for the management of cancer survivors, and experts have not reached consensus on the structure, content, and development of survivorship care guidelines. As a result, there are still many differences among countries regarding the research and practice in this field, which may be explained, in part, by the specific social and cultural factors that influence and shape the unique survivorship care scenarios for every country.

International differences in health care systems and delivery are also notable. Many countries in Europe, such as France, Italy, and the United Kingdom, offer free access to public health care, whereas the United States does not, potentially contributing to limitations in access to quality cancer care for poorer individuals and those without adequate health care coverage. However, compared with European countries, the commitment of patient advocacy is traditionally stronger in the United States, which has led the way in promoting the application of research findings into practice.

With increasing focus on the issues of long-term cancer survivorship in clinical care, public policy, and research initiatives, Europe and the United States are trying to respond in an even better and more targeted manner to this change in the health trajectory of patients diagnosed with cancer, with the main objective being to meet the needs of these individuals. In 2004, the report produced by the President's Cancer Panel following the first meeting of “Living Beyond Cancer: A European Dialogue,” held in Lisbon, Portugal on May 27 to 28, 2003 represented the first attempt to create a dialogue between the United States and Europe.[1] The Panel stated that “a key objective of the meeting was to learn about health services and survivorship activities in diverse European nations and health systems that might benefit survivors in this country.”[1] Building on this effort, since 2008 a series of scientific meetings have been sponsored by the Italian National Cancer Institutes that have brought together European and American cancer survivorship researchers to exchange ideas and foster new collaborations. The most recent of these meetings, the CME Course ESO (European School of Oncology)-OECI (Organization of European Cancer Institutes) International Symposium on Cancer Survivorship “State of the Art of Cancer Survivorship Research: Symptom Management, Psychosocial Care, and Rehabilitation” held in Bari, Italy between April 26 and 28, 2012, included representatives from 12 European nations along with distinguished scientists from Turkey and the United States.[2] A notable outcome of this meeting was the formation of the European Collaborative Group on Cancer Survivorship, which established as its initial objective to develop and share a cross-cultural plan of research, knowledge, comparison, education, and dissemination of findings to face the new challenges within the field of cancer survivorship. Similar international collaborative efforts have begun to emerge elsewhere as well, such as the Cancer and Primary Care Research International Network, which was formed in 2008 to promote international cooperation among the primary care and cancer researcher communities.

This supplement to Cancer was born of a desire to maintain the momentum initiated by the 2003 European Panel as well as the subsequent international meetings and collaborative groups, highlighting the potential differences and similarities that exist between American and European approaches to cancer survivorship issues and to promote an exchange of information. We hoped that by stimulating a dialogue among researchers from both sides of the Atlantic ocean, through jointly written articles addressing various aspects of cancer survivorship, with the similarities, disparities, and problems viewed from the point of view of each author's respective continent, we might create a springboard for increased collaboration and the development of a shared care model to improve the quality of cancer care. The task of getting authors on different continents, in different time zones, and who often spoke different primary languages to write an article together was indeed a challenge. However, these authors rose to the occasion, exchanged information and ideas, and produced articles that speak to both the similarities and differences in these cancer survivorship issues as they are approached from European and American perspectives. We hope that this may represent a new model of cooperation between the 2 sides of the Atlantic, which is fruitful not only in the field of scientific research but also in that of care, ultimately bringing improvements to the growing population of cancer survivors. Of course, we acknowledge that much survivorship research is being conducted beyond Europe and the United States, specifically in Australia, Canada, and Asia, with emerging research programs and efforts occurring in Africa, South America, and the Middle East as well. Therefore, the current effort represents just a stepping off point for international dialogue and collaboration around the issues that cancer survivors face irrespective of their locale. Indeed, although this collection of articles may only scratch the surface of a dialogue that is potentially immense, we hope to have made a small step toward the ideal of international collaboration by presenting you, the reader, with material that makes you think, reflect, and ultimately expand your horizons.

FUNDING SUPPORT

  1. Top of page
  2. Abstract
  3. FUNDING SUPPORT
  4. CONFLICT OF INTEREST DISCLOSURES
  5. REFERENCES

This supplement was sponsored by the National Cancer Research Centre Istituto Tumori “Giovanni Paolo II” Bari (Italy) through the Italian Ministry of Health-funded research project “Multidimensional assessment of long-term cancer survivors including discovery of genetic bases of susceptibility, depressive stage, prevention of affective disorders,” and through intramural funding of the American Cancer Society's Behavioral Research Center.

Through jointly written articles addressing various aspects of cancer survivorship offered from the point of view of each author's respective continent, the present supplement to Cancer is intended to stimulate an international dialogue among researchers for increased collaboration and aid in the development of a shared care model to improve the quality of life of cancer survivors worldwide.

CONFLICT OF INTEREST DISCLOSURES

  1. Top of page
  2. Abstract
  3. FUNDING SUPPORT
  4. CONFLICT OF INTEREST DISCLOSURES
  5. REFERENCES

The authors made no disclosures.

REFERENCES

  1. Top of page
  2. Abstract
  3. FUNDING SUPPORT
  4. CONFLICT OF INTEREST DISCLOSURES
  5. REFERENCES
  • 1
    The President's Cancer Panel. Living Beyond Cancer: A European Dialogue. President's Cancer Panel 2003-2004 Annual Report Supplement. Bethesda, MD: National Cancer Institute, National Institutes of Health, US Department of Health and Human Services; 2004. deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp03-04rpt/Supplement.pdf. Accessed September 7, 2012.
  • 2
    Mattioli V. Cancer Survivorship: An Emerging Problem in Italy. From the American Data to the Italian Project PIO 7 [review]. National Cancer Research Centre Istituto Tumori “Giovanni Paolo II” Bari (Italy); 2008, Human Health Foundation Onlus, Spoleto, Italy. www.hhfonlus.org.