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Survivorship Care Planning: Unique Opportunity to Champion Integrative Oncology?

Survivorship Care Planning: Unique Opportunity to Champion Integrative Oncology? DOI:10.1093/jncimonographs/lgu037 Published by Oxford University Press 2014. Survivorship Care Planning: Unique Opportunity to Champion Integrative Oncology? Julia H. Rowland, Ann O’Mara Correspondence to: Julia H. Rowland, PhD, Office of Cancer Survivorship, 9609 Medical Center Drive, Room 4E450, Bethesda, MD 20892-9764 (e-mail: row- landj@mail.nih.gov). Already numbering 13.7 million and growing rapidly, cancer survivors therapies, which for growing numbers of cancer survivors may be have taught us two important lessons. First, even when cancer treat- ongoing years after curative therapy ends, must all be adequately ment ends, the cancer experience does not. Rather, the transition from addressed. Mind-body therapies, such as yoga and tai chi, also face active treatment to recovery ushers in a whole new period in the can- challenges similar to the more conventional cognitive-behavioral cer journey, often referred to as survivorship (1). The second lesson therapies, with respect to selecting an appropriate control arm, learned, a corollary to the first, is that cancer and its treatment have the maintenance of treatment fidelity, and participant adherence. capacity to affect not simply physical well-being, but also virtually every To date, few treatment centers or clinics provide systematic ori- aspect of an individual’s life, including psychological, social, economic entation to CAM therapies, and many survivors still do not ask about and existential health and function. While some of these effects (eg, the utility of these in managing their long-term health and function. alopecia, nausea, and vomiting) dissipate rapidly once treatment ends, In addition, opportunities to implement an integrative model of care others (eg, fatigue, sexual dysfunction, memory problems) can persist must be carefully balanced against what is known to be safe and effec- over time, in some cases (eg, lymphedema, pain syndromes), becoming tive. Unfortunately, data are lacking on what practice to recommend chronic. Still another set of effects may appear months or years after to whom and for what, or the safety, mechanism of effect and efficacy treatment ends (cardiac dysfunction, osteoporosis, diabetes), the most of many CAM interventions to address troublesome posttreatment worrisome of these being recurrent or second cancers (1). concerns. Further, there is no evidence to suggest that specific CAM Today, most oncology practitioners recognize the need to con- practices may positively or negatively affect recurrence or prevent sider cancer’s long-term impact on their patients’ overall health and new cancers. More research, both descriptive and interventional, is function. However, how best to do this remains a challenge (2). The needed if we are to remedy this situation and promote a model of evolving mandate to develop survivorship care plans, inclusive of posttreatment care that embraces care for the whole patient. plans to address psychosocial needs and provision of counsel about health promotion, presents a unique opportunity for advancing an References integrative model of cancer care for those entering this new phase. 1. Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Cancer survivors are already employing a menu of comple- Survivor: Lost in Transition. Washington, DC: Institute of Medicine, National Academies Press; 2006. mentary and alternative medicine (CAM) practices to manage the 2. Adler NE, Page AEK, eds. Cancer Care for the Whole Patient: Meeting chronic effects of treatment, reduce the risk of recurrence or sec- Psychosocial Health Needs. Washington, DC: Institute of Medicine, National ond cancers, gain control over their lives, address comorbid condi- Academies Press; 2007. tions exacerbated by illness, and, ultimately, improve their quality 3. Mao JJ, Palmer CS, Healy KE, Desai K, Amsterdam J. Complementary and of life. Population-based studies report usage rates ranging from alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv. 2011;5(1):8–17. 65% (ever used) to 40% (used in the past year) (3); and data sug- 4. Sohl SJ, Weaver KE, Birdee G, Kent EE, Danhauer SC, Hamilton gest rates are not diminishing over time (4). Within the spectrum AS. Characteristics associated with the use of complementary health of treating the lingering and late effects of cancer, some promising approaches among long-term cancer survivors. Support Care Cancer. interventions are emerging. For example, ginseng and yoga have 2014;22(4):927–936. shown promise in symptom management trials of fatigue and sleep 5. Barton DL, Liu H, Dakhil SR, et al. Wisconsin Ginseng (Panax quinque- folius) to improve cancer-related fatigue: a randomized, double-blind trial, disturbances respectively, both chronic problems reported fre- N07C2. J Natl Cancer Inst. 2013;105(16):1230–1238. quently by cancer survivors (5,6). Given the documented positive 6. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized con- association between quality of life and survival, there is arguably an trolled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. important role for CAM use in recovery and life after cancer. 2013;31(26):3233–3241. Many of the challenges in conducting CAM research among survivors are not unique to the field. As with any intervention trial, Affiliations of authors: Office of Cancer Survivorship, Division of Cancer issues of quality control, standardization, as well as understanding Control and Population Sciences (JHR) and Division of Cancer Prevention how the treatment might interact with adjuvant or maintenance (AO), National Cancer Institute, National Institutes of Health, Bethesda, MD. Journal of the National Cancer Institute Monographs, No. 50, 2014 285 Downloaded from https://academic.oup.com/jncimono/article-abstract/2014/50/285/913200 by Ed 'DeepDyve' Gillespie user on 04 February 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JNCI Monographs Oxford University Press

Survivorship Care Planning: Unique Opportunity to Champion Integrative Oncology?

Rowland, Julia H.; O’Mara, Ann
JNCI Monographs , Volume 2014 (50) – Nov 4, 2014
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Publisher
Oxford University Press
Copyright
Published by Oxford University Press 2014.
ISSN
1052-6773
eISSN
1745-6614
DOI
10.1093/jncimonographs/lgu037
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25749589
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Abstract

DOI:10.1093/jncimonographs/lgu037 Published by Oxford University Press 2014. Survivorship Care Planning: Unique Opportunity to Champion Integrative Oncology? Julia H. Rowland, Ann O’Mara Correspondence to: Julia H. Rowland, PhD, Office of Cancer Survivorship, 9609 Medical Center Drive, Room 4E450, Bethesda, MD 20892-9764 (e-mail: row- landj@mail.nih.gov). Already numbering 13.7 million and growing rapidly, cancer survivors therapies, which for growing numbers of cancer survivors may be have taught us two important lessons. First, even when cancer treat- ongoing years after curative therapy ends, must all be adequately ment ends, the cancer experience does not. Rather, the transition from addressed. Mind-body therapies, such as yoga and tai chi, also face active treatment to recovery ushers in a whole new period in the can- challenges similar to the more conventional cognitive-behavioral cer journey, often referred to as survivorship (1). The second lesson therapies, with respect to selecting an appropriate control arm, learned, a corollary to the first, is that cancer and its treatment have the maintenance of treatment fidelity, and participant adherence. capacity to affect not simply physical well-being, but also virtually every To date, few treatment centers or clinics provide systematic ori- aspect of an individual’s life, including psychological, social, economic entation to CAM therapies, and many survivors still do not ask about and existential health and function. While some of these effects (eg, the utility of these in managing their long-term health and function. alopecia, nausea, and vomiting) dissipate rapidly once treatment ends, In addition, opportunities to implement an integrative model of care others (eg, fatigue, sexual dysfunction, memory problems) can persist must be carefully balanced against what is known to be safe and effec- over time, in some cases (eg, lymphedema, pain syndromes), becoming tive. Unfortunately, data are lacking on what practice to recommend chronic. Still another set of effects may appear months or years after to whom and for what, or the safety, mechanism of effect and efficacy treatment ends (cardiac dysfunction, osteoporosis, diabetes), the most of many CAM interventions to address troublesome posttreatment worrisome of these being recurrent or second cancers (1). concerns. Further, there is no evidence to suggest that specific CAM Today, most oncology practitioners recognize the need to con- practices may positively or negatively affect recurrence or prevent sider cancer’s long-term impact on their patients’ overall health and new cancers. More research, both descriptive and interventional, is function. However, how best to do this remains a challenge (2). The needed if we are to remedy this situation and promote a model of evolving mandate to develop survivorship care plans, inclusive of posttreatment care that embraces care for the whole patient. plans to address psychosocial needs and provision of counsel about health promotion, presents a unique opportunity for advancing an References integrative model of cancer care for those entering this new phase. 1. Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Cancer survivors are already employing a menu of comple- Survivor: Lost in Transition. Washington, DC: Institute of Medicine, National Academies Press; 2006. mentary and alternative medicine (CAM) practices to manage the 2. Adler NE, Page AEK, eds. Cancer Care for the Whole Patient: Meeting chronic effects of treatment, reduce the risk of recurrence or sec- Psychosocial Health Needs. Washington, DC: Institute of Medicine, National ond cancers, gain control over their lives, address comorbid condi- Academies Press; 2007. tions exacerbated by illness, and, ultimately, improve their quality 3. Mao JJ, Palmer CS, Healy KE, Desai K, Amsterdam J. Complementary and of life. Population-based studies report usage rates ranging from alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv. 2011;5(1):8–17. 65% (ever used) to 40% (used in the past year) (3); and data sug- 4. Sohl SJ, Weaver KE, Birdee G, Kent EE, Danhauer SC, Hamilton gest rates are not diminishing over time (4). Within the spectrum AS. Characteristics associated with the use of complementary health of treating the lingering and late effects of cancer, some promising approaches among long-term cancer survivors. Support Care Cancer. interventions are emerging. For example, ginseng and yoga have 2014;22(4):927–936. shown promise in symptom management trials of fatigue and sleep 5. Barton DL, Liu H, Dakhil SR, et al. Wisconsin Ginseng (Panax quinque- folius) to improve cancer-related fatigue: a randomized, double-blind trial, disturbances respectively, both chronic problems reported fre- N07C2. J Natl Cancer Inst. 2013;105(16):1230–1238. quently by cancer survivors (5,6). Given the documented positive 6. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized con- association between quality of life and survival, there is arguably an trolled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. important role for CAM use in recovery and life after cancer. 2013;31(26):3233–3241. Many of the challenges in conducting CAM research among survivors are not unique to the field. As with any intervention trial, Affiliations of authors: Office of Cancer Survivorship, Division of Cancer issues of quality control, standardization, as well as understanding Control and Population Sciences (JHR) and Division of Cancer Prevention how the treatment might interact with adjuvant or maintenance (AO), National Cancer Institute, National Institutes of Health, Bethesda, MD. Journal of the National Cancer Institute Monographs, No. 50, 2014 285 Downloaded from https://academic.oup.com/jncimono/article-abstract/2014/50/285/913200 by Ed 'DeepDyve' Gillespie user on 04 February 2018

Journal

JNCI Monographs – Oxford University Press

Published: Nov 4, 2014

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