Putting Survivorship into Clinical Practice: Program Implications from the Cancer Survivorship Research Roundtable

July 2011 Vol 2, No 4
Michael L. Krychman, MD
Southern California Center for Sexual Health & Survivorship Medicine, Newport Beach, California

Outcomes from the roundtable held in conjunction with the George Washington Cancer Institute Cancer Survivorship Research and Health Disparities Symposium have far-reaching implications that will impact clinical practice and how we, as clinicians, address cancer survivorship care in the future.

With the publication of the Instit ute of Medicine report,1 many cancer institutions are struggling to operationalize and functionalize survivorship care programs. The paradigm is often unique and untested. Each cancer center continues to struggle with how to define survivorship, survivorship care planning, and the medical and psychologic aspects that should be addressed for its patients. At present, survivorship care programs are ill-defined, and comprehensive care plans lack thoughtful consistency. Survivorship cancer care not only addresses prevention and early detection of new or recurrent cancers, but also includes surveillance for cancer progression and secondary cancers.

Interventions for medical, psychologic, sexual, and social ramifications of cancer coupled with financial and legal support for people living with cancer are warranted. The complexity of this type of multifaceted care will require specialized training programs that educate healthcare professionals so they become proficient in clinical survivorship care. Formalized training for medical and allied healthcare professionals presently is lacking. Clinical training programs will need to be systematically developed.

Healthcare professionals need formalized training to address the uniqueness of survivorship care. Providers need to integrate and address the clinical and sociocultural barriers so that they may be able to provide optimum survivorship care. The complexities of care will involve multiple specialties, where shared medical information will be critical. Electronic health records may address some of these concerns with advances in data s haring. Insurance constraints and fina ncial reimbursement may influence and dictate care. Underserved patients face unique barriers to excellent care and have distinctive problems as outlined by Pratt-Chapman.

Clinical outcomes data combined with costeffective and efficient care ultimately will need to be addressed in the clinical setting. Perhaps most importantly, medical professionals remain deficient in effectiv e com municat ion skills. Providers often lack cross-cultural awareness and sensitivity. Formalized educational programs that are culturally sensitive and provide a comprehensive survivorship curriculum will need to be implemented. Certi fication programs and clinical competencies will need to be formalized.

The combination of survivorship care planning, effective and efficient navigation, and culturally sensitive clinical care that is accessible for all survivors, including the underserved, will be a formidable task. The mandate and outline has clarity; we, however, have much to accomplish so that all our cancer survivors will avoid being lost in transition.


  1. Hewitt M, Greenfield S, Stoval E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006.

Dr Krychman is a consultant for Boehringer Ingelheim.

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