Cancer survivors referred to a long-term survivorship outpatient service within academic medical oncology: descriptive study



Long-term cancer survivors (LTCS) are a vulnerable and continued growing population. To date, only few studies have been conducted in the Spanish population; none of them with a comprehensive analysis of the most common problems identified for cancer survivors in order to improve their care and quality of life.


We conducted an observational descriptive study in 347 patients recruited between January 2015 and December 2016 from our newly created medical office for the specific care and follow-up of LTCS. Variables that describe the medical history were completed by the oncologist and measures on common problems previously reported for LTCS, related to cancer diagnosis and treatment, function, lifestyle, and emotional concerns, were collected from the patient.


The mean age of our patients was 65.1 years at the time of the study and a median time without any antitumor treatment of 5.7 years. At the time of cancer diagnosis, 298 patients (85.9%) had at least one related chronic disease and 184 patients (53%) were retired. In addition, in 17.9% of those who continued working, income had been reduced. The incidence of health problems showed an increase during follow-up, even after 5 years, and required evaluation in an emergency department in 157 cases (45.3%). Regardless of age or sex, 239 patients (68.9%) had a significant decrease in sexual activity and 120 (34.6%) were diagnosed with clinical depression.


LTCS are patients with significantly high socioeconomic, labor, sexual, health, and psychological problems, 5 years after completion of cancer treatment, especially in older survivors.

Implications for Cancer Survivor

Common concerns of LTCS were identified and are consistent across many countries. It is important to realize that even 5 or so years following treatment, both medical and non-medical problems can exist and may need attention by an expert.

This is a preview of subscription content, access via your institution.

Fig. 1



Confidence interval


Hospital Anxiety and Depression Scale


Interquartile range


International Federation of Gynecology and Obstetrics


Long-term cancer survivor


Spanish Network of Cancer Registries


Society of Medical Oncology


Short form


Odds ratio


Visual analogue scale


  1. 1.

    De Angelis R, Sant M, Coleman MP, EUROCARE 5 Working Group, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population based study. Lancet Oncol. 2014;15:23–34.

    Article  Google Scholar 

  2. 2.

    Las Cifras del Cáncer en España 2016 [Internet]. Sociedad Española de Oncología Médica. Available at: Last accessed 29 October 2018.

  3. 3.

    Galceran J, Ameijide A. Carulla et al. REDECAN Working Group. Cancer incidence in Spain, 2015. Clin Transl Oncol. 2017 Jul;19(7):799–825.

    Article  CAS  Google Scholar 

  4. 4.

    Cancer Treatment & Survivorship Facts & Figures 2016 [Internet]. American Cancer Society. Available at: Last accessed 4 March 2019.

  5. 5.

    Brozos Vázquez E, Vázquez Rivera F, Cueva Bañuelos J, Barón Duarte FJ. Supervivientes al cáncer en España: Situación actual, Monográfico SEOM de largos supervivientes en cáncer [Internet]. Sociedad Española de Oncología Médica. Available at: Last accessed 3 November 2020.

  6. 6.

    Shakeel S, Tung J, Rahal R, Finley C. Evaluation of factors associated with unmet needs in adult cancer survivors in Canada. JAMA Netw Open. 2020;3(3):e200506.

    Article  Google Scholar 

  7. 7.

    Nelson MB, Meeske K. Recognizing health risk in childhood cancers survivors. J Am Acad Nurse Pract. 2005;17:96–103.

    Article  Google Scholar 

  8. 8.

    Reulen RC, Winter DL, Lancashire ER, Zeegers MP, Jenney ME, Walters SJ, et al. Health-status of adult survivors of childhood cancer: a large-scale population-based study from the British Childhood Cancer Survivor Study. Int J Cancer. 2007;121(3):633–40.

    Article  CAS  Google Scholar 

  9. 9.

    Bouhnik AD, Bendiane MK, Cortaredona S, et al. The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey). BMJ Open. 2015;5:3.

    Article  Google Scholar 

  10. 10.

    Ben Charif A, Bouhnik AD, Courbière B, Rey D, Préau M, Bendiane MK, et al. Sexual health problems in French cancer survivors 2 years after diagnosis-the national VICAN survey. J Cancer Surviv. 2016;10(3):600–9.

    Article  Google Scholar 

  11. 11.

    Rowland JH, Kent EE, Forsythe LP, et al. Cancer survivorship research in Europe and the United States: where have we been, where are we going, and what can we learn from each other? Cancer. 2013;119(Suppl 11(011)):2094–108.

    Article  Google Scholar 

  12. 12.

    Truant TL, Fitch MI, O'Leary C, Stewart J. Global perspectives on cancer survivorship: from lost in transition to leading into the future. Can Oncol Nurs J. 2017;27(3):287–94.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Maddison AR, Asada Y, Urquhart R. Inequity in access to cancer care: a review of the Canadian literature. Cancer Causes Control. 2011;22(3):359–66.

    Article  Google Scholar 

  14. 14.

    Zhao Y, Brettle A, Qiu L. The effectiveness of shared care in cancer survivors-a systematic review. Int J Integr Care. 2018;18(4):2.

    Article  Google Scholar 

  15. 15.

    Lagergren P, Schandl A, Aaronson NK, Adami HO, Lorenzo F, Denis L, et al. Cancer survivorship: an integral part of Europe's research agenda. Mol Oncol. 2019;13(3):624–35.

    Article  Google Scholar 

  16. 16.

    Halpern MT, McCabe MS, Burg MA. The cancer survivorship journey: models of care, disparities, barriers, and future directions. Am Soc Clin Oncol Educ Book. 2016;35:231–9.

    Article  Google Scholar 

  17. 17.

    Brierley J, Gospodarowicz MK, Wittekind CH (Eds.). TNM classification of malignant tumours. 8th ed. Oxford; Hoboken: John Wiley & Sons, Inc.; 2017.

  18. 18.

    Gotay CC, Pagano IS. Assessment of survivor concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes. 2007;5:15.

    Article  Google Scholar 

  19. 19.

    Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36) (I). Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  Google Scholar 

  20. 20.

    Alonso J, Prieto L, Anto JM. La versión española del SF-36 Heatlh Survey (Cuestionario de Salud SF 36): un instrumento para la medida de los resultados clínicos. Med Clin. 1995;104:771–6.

    CAS  Google Scholar 

  21. 21.

    Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77.

    Article  Google Scholar 

  22. 22.

    Quintana JM, Padierna A, Esteban C, Arostegui I, Bilbao A, Ruiz I. Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 2003 Mar;107(3):216–21.

    Article  CAS  Google Scholar 

  23. 23.

    Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961–5.

    Article  CAS  Google Scholar 

  24. 24.

    Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2013;31:4465–70.

    Article  Google Scholar 

  25. 25.

    Kline RM, Arora NK, Bradley CJ, Brauer ER, Graves DL, Lunsford NB, et al. Long-term survivorship care after cancer treatment - summary of a 2017 National Cancer Policy Forum Workshop. J Natl Cancer Inst. 2018;110(12):1300–10.

    Article  Google Scholar 

  26. 26.

    Mitchell AJ, Ferguson DW, Gill J, et al. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol. 2013;14(8):721–32.

    Article  Google Scholar 

  27. 27.

    Gunnes MW, Lie RT, Bjørge T, Ghaderi S, Syse A, Ruud E, et al. Suicide and violent deaths in survivors of cancer in childhood, adolescence and young adulthood-a national cohort study. Int J Cancer. 2017 Feb;140(3):575–80.

    Article  CAS  Google Scholar 

  28. 28.

    McDougall GJ Jr, Oliver JS, Scogin F. Memory and cancer: a review of the literature. Arch Psychiatr Nurs. 2014 Jun;28(3):180–6.

    Article  Google Scholar 

  29. 29.

    Encuesta Nacional de Salud 2011-2012 [Internet]. Instituto Nacional de Estadística, España. Available at: Last accessed 25 November 2018.

  30. 30.

    Hudson MM, Tyc VL, Jayawardene DA, Gattuso J, Quargnenti A, Greenwald C, et al. Feasibility of implementing health promotion interventions to improve health-related quality of life. Int J Cancer Suppl. 1999;12:138–42.

    Article  CAS  Google Scholar 

  31. 31.

    Nathan PC, Ford JS, Henderson TO, et al. Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27(14):2363–73.

    Article  Google Scholar 

  32. 32.

    Paul CL, Tzelepis F, Boyes AW, et al. Continued smoking after a cancer diagnosis: a longitudinal study of intentions and attempts to quit. J Cancer Surviv. 2019;13:687–94.

    Article  Google Scholar 

  33. 33.

    Cortés-Ibáñez FO, Jaramillo-Calle DA, Vinke PC, et al. Comparison of health behaviours between cancer survivors and the general population: a cross-sectional analysis of the Lifelines cohort. J Cancer Surviv. 2020;14:377–85.

    Article  Google Scholar 

  34. 34.

    Azrad M, Demark-Wahnefried W. The association between adiposity and breast cancer recurrence and survival: a review of the recent literature. Curr Nutr Rep. 2014;3(1):9–15.

    Article  CAS  Google Scholar 

  35. 35.

    Shankar A, Prasad N, Roy S, et al. Sexual dysfunction in females after cancer treatment: an unresolved issue. Asian Pac J Cancer Prev. 2017 May;18(5):1177–82.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Junuzovic D, Hasanbegovic M, Omerbegovic D. Erectile dysfunction as a complication after treatment of prostate cancer. Mater Soc. 2011;23(4):230–1.

    Article  Google Scholar 

  37. 37.

    Bober SL, Michaud AL, Recklitis CJ. Finding sexual health aids after cancer: are cancer centers supporting survivors’ needs? J Cancer Surviv. 2019;13:224–30.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Alejandro Gallego.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gallego, A., Martínez, B., Ghanem, I. et al. Cancer survivors referred to a long-term survivorship outpatient service within academic medical oncology: descriptive study. J Cancer Surviv (2020).

Download citation


  • Long-term Cancer Survivor
  • Follow-up
  • Quality of life
  • Care plan