Many people with cancer receive long-term therapy after their primary cancer treatment—such as surgery or chemotherapy—has ended, in order reduce the risk of their cancer returning or worsening. In today’s podcast, Dr. Ryan Nipp discusses the unique challenges faced by people who receive this extended therapy and their caregivers. Dr. Nipp also talks about the importance of survivorship care plans and having open communication between patients and their health care team in addressing these challenges.
ASCO: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
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This podcast is part of a series featuring articles from the 2017 ASCO Educational Book. Published annually, the Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology.
Many people with cancer receive long-term therapy after their primary cancer treatment—such as surgery or chemotherapy—has ended, in order reduce the risk of their cancer returning or worsening. In today’s podcast, Dr. Ryan Nipp discusses the unique challenges faced by people who receive this extended therapy and their caregivers. Dr. Nipp also talks about the importance of survivorship care plans and having open communication between patients and their health care team in addressing these challenges. Dr. Nipp is gastrointestinal oncologist and health services researcher at Massachusetts General Hospital.
ASCO would like to thank Dr. Nipp for discussing this topic.
Dr. Nipp: Hello, my name is Ryan Nipp. I’m from Massachusetts General Hospital. In this podcast, I will be sharing some of the key points from the 2017 ASCO Educational Book article titled, “Addressing the Survivorship Care Needs of Patients Receiving Extended Cancer Treatment.”
For many patients, cancer may be a chronic disease that requires treatment long after the initial diagnosis and primary cancer treatment, including surgery, chemotherapy, or radiation therapy. This is known as extended therapy. Patients may receive extended treatment in hopes of preventing the cancer from returning or worsening.
Unfortunately, patients who receive extended cancer treatment may experience some ongoing challenges related to the cancer or its treatment. People may struggle to remember to take their medication on time and on the appropriate schedule, particularly those who have to take medications for many years. Additionally, patients receiving extended therapy may experience side effects from their medications, which in turn can affect their quality of life. Thus, ongoing research efforts are needed which focus on the health outcomes and quality of life of individuals with cancer beyond the diagnosis and treatment phases.
Extended cancer treatment is recommended for different people for different reasons. Some patients whose cancer has been cured may need to be on extended treatment to prevent their cancer from returning. For example, women with early-stage breast cancer whose disease has been cured using surgery or radiation therapy may be prescribed endocrine therapy, which is also known as hormonal therapy.
Endocrine therapy is taken by mouth, but it usually needs to be taken every day for multiple years. This medication can cause side effects, which may help explain why data suggest that many women prescribed tamoxifen (which is a type of endocrine therapy) stopped taking their medication as prescribed by the fourth year of therapy.
Some patients need extended treatment to help control their disease, even if the medication may not ultimately cure their cancer. These people may receive targeted therapies, which prevent the disease from growing, spreading, or progressing.
For example, patients with chronic myelogenous leukemia (or CML for short) often take a medication known as a tyrosine kinase inhibitor daily for an extended period of time. This treatment, known as a targeted therapy, can help keep the disease from getting worse, and patients are often asked to remain adherent to this treatment for many years.
Like patients on long-term endocrine therapy, patients on long-term targeted therapy can have a hard time staying on the medication, often because of the side effects. One of the keys to successful survivorship care plans for patients who require extended therapy is to ensure that they keep taking the medication regularly. Survivors can talk to their physicians about side effects from these medications so that those side effects can be better controlled.
Lastly, patients with advanced cancer often experience complex supportive care needs when it comes to maintaining quality of life on extended therapy. Patients in this group often seek new treatments that can extend their lives, but they may have a number of additional survivorship and supportive care needs, including managing side effects, prognostic uncertainty, financial distress, and family caregiver support.
A key component of caring for these patients is open communication. Patients and doctors should have an honest discussion about the patient’s prognosis and illness understanding. In addition, efforts are needed to focus on how the cost of treatment can impact both the patient, and their family.
Friends and family of patients with cancer, also known as family caregivers, often experience symptoms such as fatigue, sleep problems, depression, and anxiety. In addition to negatively affecting the caregiver’s health, these demands can impact their ability to effectively care for their loved ones.
In summary, for many people with cancer, their care will involve extended treatment over long periods of time. This reality challenges the paradigm that has defined survivorship care and research to date. No longer should survivorship care simply focus on the period right after patients complete active treatment, but additional research is needed that focuses on survivorship care throughout the cancer trajectory.
To learn more, please view my article online at ASCO.org/edbook for an in-depth discussion of this topic. Thank you.
ASCO: Thank you Dr. Nipp. Please visit ASCO.org/edbook to read the full article. And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.
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