<i>Journal of Clinical Oncology</i> Update on Progress in Cancer Survivorship Care and Research

It has been 7 years since the Institute of Medicine (IOM) issued its report, entitled From Cancer Patient to Cancer Survivor: Lost in Transition, and a similar interval since Journal of Clinical Oncology published a special series issue on cancer survivorship. Since that time, much has occurred to address the 10 recommendations of the IOM report that were highlighted in the JCO series and explicated among the articles in that special issue. Of particular note, many of the articles in the JCO special issue were prepared by members of the IOM study committee; others were from leaders in the emerging field of survivorship care. These individual articles largely examined specific issues and recommendations that were raised in the IOM report, such as monitoring the health of survivors, care planning, models of care delivery, and enhancing research on cancer survivors, as a call to action and reinforcement of the recently issued report. This special series issue of JCO reflects the maturation of the field of cancer survivorship clinical care and health care delivery, with an array of articles that examine many of the untoward immediate, persistent, and late effects of cancer treatment. Some of these problems can be considered preventable or addressable given high-quality survivorship care, such as fertility preservation (see article by Ruddy and Partridge) or lymphedema (see article by Paskett et al). Other outcomes go with the territory of using potentially carcinogenic agents to treat and cure cancer (see article by Wood et al on second malignancies). The risk-adapted therapies that are currently employed, including avoidance of the use of radiation therapy when possible, and tailoring therapy to the severity of disease, may reduce these outcomes in the future. Other common health problems and survivorship concerns that were addressed in this issue include bone health (Lustberg et al), troublesome and frequent symptoms and their management (see articles by Pachman et al and Ahles et al), sexuality concerns (articles by Bober and Sanchez Varela and Higano), and cardiac complications in survivors (Lenihan and Cardinale). Although many other organ systems and toxicities could be reviewed, these areas were chosen because of their frequency or severity among survivors as well as the robustness of the literature and evidence base. Other articles in this issue provide in-depth examination of survivorship outcomes in patients with a high likelihood of survival, such as those with germ cell tumors of the testes and adult survivors of hematopoietic stem-cell transplantation (Haugnes et aland Syrjala et al). These two patient/survivor groups represent the extremes of outcomes, with relatively limited sequelae among the survivors of testes cancer compared with the extreme physical and psychological impairments that are noted among survivors of transplantation. Both articles suggest models of care that are useful for consideration. The remaining articles in this issue focus on health promotion and care coordination, both of which were highlighted in the earlier JCO survivorship issue. The article by Ligibel emphasizes the importance of energy balance, nutritional factors, and obesity as potential risk factors for cancer recurrence in survivors of cancer; these issues are even more salient given our societal obesity epidemic. Regular physical activity is highlighted as a strategy for cancer recurrence prevention as well as weight control. Addressing smoking and alcohol use in survivors is discussed; lifestyle recommendations and guidelines for survivors are also provided. Finally, Earle and Ganz address the challenges of implementation of survivorship care planning, which was the second recommendation of the IOM report. This topic has been the most problematic for the oncology community and is still in need of practical and cost-efficient solutions, but progress is being made. As the authors note, we should not let the perfect be the enemy of the good in trying to deliver coordinated survivorship care. The perfect models for delivery of survivorship care to the millions of survivors of cancer worldwide is still a work in progress, and will probably require additional evolution and refinement, as well as the information technology infrastructure to make it feel seamless. Absent from this issue is a focus on the psychosocial needs and concerns of survivors of cancer, which is an essential component of high-quality cancer care, as described in two IOM reports. Fortunately, an entire recent issue of JCO focused on these issues, and we call your attention to an article by Stanton that reviews the special concerns for survivors and provides an update on an article written for the 2006 JCO issue on cancer survivorship. In addition, in the current special series issue, we do not review employment and insurance issues, which remain an important concern for survivors of cancer and were previously discussed by Short and Vargo. Employment and health insurance concerns are by no means diminished for survivors and have probably been intensified by the worldwide financial crisis. In the United States, where health care finance and reform have held center stage for the last 3 years, lack of universal access to health insurance still remains a problem. JOURNAL OF CLINICAL ONCOLOGY S P E C I A L S E R I E S O V E R V I E W VOLUME 30 NUMBER 30 OCTOBER 2

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