The follow up of cancer survivors
Cancer patients now live nearly six times longer after their cancer diagnosis than was the case 40 years ago with the median survival time increasing from one year to six years (Macmillan Cancer Support Nov 2011). Indeed in 2009 it was estimated that around 2 million people were alive in the UK with a cancer diagnosis, rising by 3% a year (Maddams et al. 2009). Whilst most cancer survivors report excellent or good health, recent published evidence indicate that cancer survivors report broadly similar health profiles to non-cancer patients with a serious chronic health condition (Elliot et al. 2011). Furthermore, a recent study to explore the incidence of long-term consequences in patients diagnosed with breast, colorectal and prostate cancer identified increases in heart failure, coronary heart disease, osteoporosis, diabetes and hypothyroidism compared with case controls (Khan et al. 2011). Although the exact numbers of cancer survivors living with treatment consequences are not accurately known, it is clear that there is an increasing population of survivors living with physical and psychological consequences of their previous diagnosis and treatment. Of the physical consequences, hormonal disruption is particularly important. Long-term and late onset treatment related effects may be significant, but are currently not routinely detected in oncology or primary care clinic settings. The absence of structured comprehensive surveillance mean that many treatment related consequences may remain undiagnosed or are not identified as soon as they could be, with subsequent health and social care resource implications. There is increasing recognition that a systematic approach to survivorship and late effects management is warranted. To address this, the Society for Endocrinologys Late Effects Special Interest Group is developing a clinical guidance. This paper considers how this clinical guidance might be implemented and what the future follow-up care for cancer survivors might hold.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.