Specific Challenges in Optimizing Health Care for Cancer Survivors

  • Jennifer Jones
  • Eva Grunfeld


In this chapter, we briefly describe the epidemiological and clinical factors that have led to the growing interest in cancer survivorship. We then describe the development of the term “cancer survivor”, reviewing definitions that have been applied to the term. Finally, we highlight the challenges that cancer survivorship poses to both patients and the health care systems.


Cancer Survivor Breast Cancer Survivor Survivorship Care Plan Oncology Specialist Survivorship Research 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al. SEER Cancer Statistics Review, 1975–2005. Bethesda, MD: National Cancer Institute; 2007.Google Scholar
  2. 2.
    Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, et al. Cancer incidence in five continents. Lyon, France: IARC Press; 2007.Google Scholar
  3. 3.
    Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS ONE. 2010;5(3):e9584.PubMedCentralPubMedGoogle Scholar
  4. 4.
    World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: AICR; 2007.Google Scholar
  5. 5.
    US Census Bureau. Projections of the population by selected age groups and sex for the United States: 2010–2050. Available from: www.projections/summarytables.html.
  6. 6.
    Canadian Cancer Society’s Steering Committee. Canadian Cancer Statistics 2009. Toronto: Canadian Cancer Society; 2009.Google Scholar
  7. 7.
    Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94(10):2766–92.PubMedGoogle Scholar
  8. 8.
    Leigh S. Cancer survivorship: defining our destiny. In: Hoffman B, editor. A cancer survivor’s almanac. Hoboken, NJ: Wiley; 2004.Google Scholar
  9. 9.
    Mullan F. Seasons of survival: reflections of a physician with cancer. N Engl J Med. 1985;313(4):270–3.PubMedGoogle Scholar
  10. 10.
    Leigh S. Survivorship. In: Burke CC, editor. Psychosocial dimensions of oncology nursing care. Pittsburgh, PA: Oncology Nursing Society; 1998. p. 129–49.Google Scholar
  11. 11.
    Twombly R. What’s in a name: who is a cancer survivor? J Natl Cancer Inst. 2004;96(19):1414–5.PubMedGoogle Scholar
  12. 12.
    Aziz NM. Cancer survivorship research: challenge and opportunity. J Nutr. 2002;132:S3494–503.Google Scholar
  13. 13.
    Aziz NM, Rowland JH. Trends and advances in cancer survivorship research: challenge and opportunity. Semin Radiat Oncol. 2003;13(3):248–66.PubMedGoogle Scholar
  14. 14.
    President’s Cancer Panel. Living beyond cancer: finding a new balance. Bethesda, MD: National Cancer Institute; 2004.Google Scholar
  15. 15.
    National Cancer Institute. About cancer survivorship research: survivorship definitions [internet]. 2010 [cited 2010 Apr 10]. Available from:
  16. 16.
    National Coalition for Cancer Survivorship. The organization: national coalition for cancer survivorship [internet]. 2010 [cited 2010 Apr 9]. Available from:
  17. 17.
    CDC and LAF (Centers for Disease Control and Prevention and the Lance Armstrong Foundation). A National Action Plan for Cancer Survivorship: advancing public health strategies. Atlanta, GA: CDC; 2004.Google Scholar
  18. 18.
    Feuerstein M. Defining cancer survivorship. J Cancer Surviv. 2007;1(1):5–7.PubMedGoogle Scholar
  19. 19.
    Institute of Medicine and National Research Council. In: Hewitt M, Greenfeld S, Stovall E (eds). From patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2005.Google Scholar
  20. 20.
    National Cancer Institute (NCI). Cancer Control Continuum [internet]. 2005 [cited 2010 Apr 10]. Available from
  21. 21.
    Institute of Medicine. Meeting psychosocial needs of women with breast cancer. Washington, DC: The National Academies Press; 2004.Google Scholar
  22. 22.
    National Cancer Institute. About cancer survivorship research: survivorship definitions [Internet]. 2004 [cited 2010 Apr 10]. Available from:
  23. 23.
    Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: National Academies Press; 2007.Google Scholar
  24. 24.
    Jacobsen PB. Clinical practice guidelines for the psychosocial care of cancer survivors. Cancer. 2009;115(18 Suppl):4419–29.PubMedGoogle Scholar
  25. 25.
    Miller KD, Triano LR. Medical issues in cancer survivors – a review. Cancer J. 2008;14(6):375–87.PubMedGoogle Scholar
  26. 26.
    Ganz PA. Survivorship: adult cancer survivors. Prim Care. 2009;36(4):721–41.PubMedGoogle Scholar
  27. 27.
    Jacobs LA, Palmer SC, Schwartz LA, DeMichele A, Mao JJ, Carver J, et al. Adult cancer survivorship: evolution, research, and planning care. CA Cancer J Clin. 2009;59(6):391–410.PubMedGoogle Scholar
  28. 28.
    Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol. 2009;27(15):2489–95.PubMedGoogle Scholar
  29. 29.
    Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, Farrar JT. Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med. 2007;20(5):434–43.PubMedGoogle Scholar
  30. 30.
    Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. American Society of Clinical Oncology Clinical Evidence Review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol. 2007;25(25):3991–4008.PubMedGoogle Scholar
  31. 31.
    Stone PC, Minton O. Cancer-related fatigue. Eur J Cancer. 2008;44(8):1097–104.PubMedGoogle Scholar
  32. 32.
    Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al. American Society of Clinical Oncology Recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24(18):2917–31.PubMedGoogle Scholar
  33. 33.
    Fossa SD, Vassilopoulou-Sellin R, Dahl AA. Long term physical sequelae after adult-onset cancer. J Cancer Surviv. 2008;2(1):3–11.PubMedGoogle Scholar
  34. 34.
    Correa DD, Ahles TA. Neurocognitive changes in cancer survivors. Cancer J. 2008;14(6):396–400.PubMedGoogle Scholar
  35. 35.
    Stewart A, Bielajew C, Collins B, Parkinson M, Tomiak E. A meta-analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clin Neuropsychol. 2006;20(1):76–89.PubMedGoogle Scholar
  36. 36.
    Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic pain in the cancer survivor: a new frontier. Pain Med. 2007;8(2):189–98.PubMedGoogle Scholar
  37. 37.
    Polomano RC, Farrar JT. Pain and neuropathy in cancer survivors. Cancer Nurs. 2006;29(2 Suppl):39–47.PubMedGoogle Scholar
  38. 38.
    Roscoe JA, Kaufman ME, Matteson-Rusby SE, Palesh OG, Ryan JL, Kohli S, et al. Cancer-related fatigue and sleep disorders. Oncologist. 2007;12(1 Suppl):35–42.PubMedGoogle Scholar
  39. 39.
    Camp-Sorrell D. Cardiorespiratory effects in cancer survivors. Cancer Nurs. 2006;29(2 Suppl):55–9.PubMedGoogle Scholar
  40. 40.
    Pelusi J. Sexuality and body image. Research on breast cancer survivors documents altered body image and sexuality. Am J Nurs. 2006;106(3 Suppl):32–8.PubMedGoogle Scholar
  41. 41.
    Ng AK, Kenney LB, Gilbert ES, Travis LB. Secondary malignancies across the age spectrum. Semin Radiat Oncol. 2010;20(1):67–78.PubMedGoogle Scholar
  42. 42.
    Brown BW, Brauner C, Minnotte MC. Non-cancer deaths in white adult cancer patients. J Natl Cancer Inst. 1993;85(12):979–87.PubMedGoogle Scholar
  43. 43.
    Newschaffer CJ, Otani K, McDonald MK, Penberthy LT. Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort. J Natl Cancer Inst. 2000;92(8):613–21.PubMedGoogle Scholar
  44. 44.
    Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol. 1999;17(1):120–9.PubMedGoogle Scholar
  45. 45.
    Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381–9.PubMedGoogle Scholar
  46. 46.
    Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol. 2002;20(15):3302–16.PubMedCentralPubMedGoogle Scholar
  47. 47.
    Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23(7):1370–80.PubMedGoogle Scholar
  48. 48.
    Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR. Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. 2006;98(8):521–9.PubMedGoogle Scholar
  49. 49.
    Bhatia S, Robison LL. Cancer survivorship research: opportunities and future needs for expanding the research base. Cancer Epidemiol Biomark Prev. 2008;17(7):1551–7.Google Scholar
  50. 50.
    Stanton AL. Psychosocial concerns and interventions for cancer survivors. J Clin Oncol. 2006;24(32):5132–7.PubMedGoogle Scholar
  51. 51.
    Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112(11 Suppl):2577–92.PubMedGoogle Scholar
  52. 52.
    Andrykowski MA, Lykins E, Floyd A. Psychological health in cancer survivors. Semin Oncol Nurs. 2008;24(3):193–201.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Costanzo ES, Ryff CD, Singer BH. Psychosocial adjustment among cancer survivors: findings from a national survey of health and well-being. Health Psychol. 2009;28(2):147–56.PubMedCentralPubMedGoogle Scholar
  54. 54.
    Mehnert A, Koch U. Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res. 2008;64(4):383–91.PubMedGoogle Scholar
  55. 55.
    Tsunoda A, Nakao K, Hiratsuka K, Yasuda N, Shibusawa M, Kusano M. Anxiety, depression and quality of life in colorectal cancer patients. Int J Clin Oncol. 2005;10(6):411–7.PubMedGoogle Scholar
  56. 56.
    Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003;30(6):779–813.Google Scholar
  57. 57.
    Alfano CM, Rowland JH. Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J. 2006;12(5):432–43.PubMedGoogle Scholar
  58. 58.
    Meyerowitz BE, Kurita K, D’Orazio LM. The psychological and emotional fallout of cancer and its treatment. Cancer J. 2008;14(6):410–3.PubMedGoogle Scholar
  59. 59.
    Urological Tumours National Working Group. Renal cell carcinoma: nation wide guideline, version 1.1. The Netherlands: Dutch Association of Comprehensive Cancer Centres; 2006.Google Scholar
  60. 60.
    Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT). Bone Marrow Transplant. 2006;37(3):249–61.PubMedGoogle Scholar
  61. 61.
    Earle CC, Chretien Y, Morris C, Ayanian JZ, Keating NL, Polgreen LA, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol. 2010;28(10):1700–5.PubMedCentralPubMedGoogle Scholar
  62. 62.
    de Boer AG, Taskila T, Ojajarvi A, van Dijk FJ, Verbeek JH. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009;301(7):753–62.PubMedGoogle Scholar
  63. 63.
    Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B. Economic stress among low-income women with cancer: effects on quality of life. Cancer. 2008;112(3):616–25.PubMedGoogle Scholar
  64. 64.
    Peuckmann V, Ekholm O, Sjogren P, Rasmussen NK, Christiansen P, Moller S, et al. Health care utilization and characteristics of long-term breast cancer survivors: nationwide survey in Denmark. Eur J Cancer. 2009;45(4):625–33.PubMedGoogle Scholar
  65. 65.
    Hoving JL, Broekhuizen ML, Frings-Dresen MH. Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer. 2009;9:117.PubMedCentralPubMedGoogle Scholar
  66. 66.
    Longo CJ, Fitch M, Deber RB, Williams AP. Financial and family burden associated with cancer treatment in Ontario, Canada. Support Care Cancer. 2006;14(11):1077–85.PubMedGoogle Scholar
  67. 67.
    SEER. Office of Cancer Survivorship, National Cancer Institute. Prevalence statistics [Internet]. 2002 [cited 2010 Apr 1]. Available from: .
  68. 68.
    Yancik R, Ries L. Aging and cancer in America: demographic and epidemiologic perspectives. Hematol Oncol Clin North Am. 2000;14:17–23.PubMedGoogle Scholar
  69. 69.
    Rao AV, Demark-Wahnefried W. The older cancer survivor. Crit Rev Oncol Hematol. 2006;60(2):131–43.PubMedGoogle Scholar
  70. 70.
    Mandelblatt JS, Edge SB, Meropol NJ, Senie R, Tsangaris T, Grey L, et al. Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol. 2003;21(5):855–63.PubMedGoogle Scholar
  71. 71.
    Chirikos TN, Russell-Jacobs A, Jacobsen PB. Functional impairment and the economic consequences of female breast cancer. Women Health. 2002;36(1):1–20.PubMedGoogle Scholar
  72. 72.
    Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58(1):82–91.PubMedGoogle Scholar
  73. 73.
    Rowland JH, Yancik R. Cancer survivorship: the interface of aging, comorbidity, and quality care. J Natl Cancer Inst. 2006;98(8):504–5.PubMedGoogle Scholar
  74. 74.
    Pinto BM, Trunzo JJ, Reiss P, Shiu SY. Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psychooncology. 2002;11(5):389–400.PubMedGoogle Scholar
  75. 75.
    Brown JK, Byers T, Doyle C, Coumeya KS, Demark-Wahnefried W, Kushi LH, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2003;53(5):268–91.PubMedGoogle Scholar
  76. 76.
    Demark-Wahnefried W, Morey MC, Clipp EC, Pieper CF, Snyder DC, Sloane R, et al. Leading the way in exercise and diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors. Control Clin Trials. 2003;24(2):206–23.PubMedGoogle Scholar
  77. 77.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23(24):5814–30.PubMedCentralPubMedGoogle Scholar
  78. 78.
    Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing! J Clin Oncol. 2005;23(24):5458–60.PubMedGoogle Scholar
  79. 79.
    Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006;56(6):323–53.PubMedGoogle Scholar
  80. 80.
    Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23(34):8884–93.PubMedGoogle Scholar
  81. 81.
    Mayer DK, Terrin NC, Menon U, Kreps GL, McCance K, Parsons SK, et al. Screening practices in cancer survivors. J Cancer Surviv. 2007;1(1):17–26.PubMedGoogle Scholar
  82. 82.
    Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med. 2005;40(6):702–11.PubMedGoogle Scholar
  83. 83.
    Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26(13):2198–204.PubMedGoogle Scholar
  84. 84.
    Findley PA, Sambamoorthi U. Preventive health services and lifestyle practices in cancer survivors: a population health investigation. J Cancer Surviv. 2009;3(1):43–58.PubMedGoogle Scholar
  85. 85.
    Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000;88(3):674–84.PubMedGoogle Scholar
  86. 86.
    Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM, et al. Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav. 2003;27(3):246–56.PubMedGoogle Scholar
  87. 87.
    Pinto BM, Eakin E, Maruyama NC. Health behavior changes after a cancer diagnosis: what do we know and where do we go from here? Ann Behav Med. 2000;22(1):38–52.PubMedGoogle Scholar
  88. 88.
    Lemon SC, Zapka JG, Clemow L. Health behavior change among women with recent familial diagnosis of breast cancer. Prev Med. 2004;39(2):253–62.PubMedGoogle Scholar
  89. 89.
    National Comprehensive Cancer Network. Clinical practice guidelines in oncology: colon cancer. National Comprehensive Cancer Network, 2010.Google Scholar
  90. 90.
    National Comprehensive Cancer Network. Clinical practice guidelines in oncology: rectal cancer. National Comprehensive Cancer Network, 2010.Google Scholar
  91. 91.
    Oncoline. Prostate cancer: nation wide guideline, version 1 [Internet]. 2007 [cited 2010 Apr 4]. Available from:
  92. 92.
    Grunfeld E, Dhesy-Thind S, Levine M. Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update). CMAJ. 2005;172(10):1319–20.PubMedCentralPubMedGoogle Scholar
  93. 93.
    Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. J Am Diet Assoc. 2003;103(3):323–8.PubMedGoogle Scholar
  94. 94.
    Satia JA, Campbell MK, Galanko JA, James A, Carr C, Sandler RS. Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomark Prev. 2004;13(6):1022–31.Google Scholar
  95. 95.
    Demark-Wahnefried W, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, et al. Physical function and associations with diet and exercise: results of a cross-sectional survey among elders with breast or prostate cancer. Int J Behav Nutr Phys Act. 2004;1(1):16.PubMedCentralPubMedGoogle Scholar
  96. 96.
    Courneya KS, Vallance JK, McNeely ML, Karvinen KH, Peddle CJ, Mackey JR. Exercise issues in older cancer survivors. Crit Rev Oncol Hematol. 2004;51(3):249–61.PubMedGoogle Scholar
  97. 97.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479–86.PubMedGoogle Scholar
  98. 98.
    Pierce JP, Faerber S, Wright FA, Newman V, Flatt SW, Kealey S, et al. Feasibility of a randomized trial of a high-vegetable diet to prevent breast cancer recurrence. Nutr Cancer. 1997;28(3):282–8.PubMedGoogle Scholar
  99. 99.
    Pierce JP, Newman VA, Flatt SW, Faerber S, Rock CL, Natarajan L, et al. Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. J Nutr. 2004;134(2):452–8.PubMedGoogle Scholar
  100. 100.
    Chlebowski RT, Blackburn GL, Elashoff RE, Thomson C, Goodman MT, Shapiro A, et al. Dietary fat reduction in postmenopausal women with primary breast cancer: Phase III Women’s Intervention Nutrition Study (WINS). J Clin Oncol (Meeting Abstracts). 2005;23(16_suppl):10.Google Scholar
  101. 101.
    McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175(1):34–41.PubMedCentralPubMedGoogle Scholar
  102. 102.
    Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull. 2008;134(5):700–41.PubMedGoogle Scholar
  103. 103.
    Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2005;14:1588–95.Google Scholar
  104. 104.
    Pinto BM, Floyd A. Theories underlying health promotion interventions among cancer survivors. Semin Oncol Nurs. 2008;24(3):153–63.PubMedGoogle Scholar
  105. 105.
    Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008. Issue 2. Art. No: DC006145. DOI:10.1002/14651858.CD006145.pub2.Google Scholar
  106. 106.
    Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression. J Natl Cancer Inst Monogr. 2004;32:150–7.PubMedGoogle Scholar
  107. 107.
    Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology. 2006;15(4):306–20.PubMedGoogle Scholar
  108. 108.
    Gritz ER, Nisenbaum R, Elashoff RE, Holmes EC. Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Control. 1991;2(2):105–12.PubMedGoogle Scholar
  109. 109.
    Hudson SV, Chubak J, Coups EJ, Blake-Gumbs L, Jacobsen PB, Neugut AI, et al. Identifying key questions to advance research and practice in cancer survivorship follow-up care: a report from the ASPO Survivorship Interest Group. Cancer Epidemiol Biomark Prev. 2009;18(7):2152–4.Google Scholar
  110. 110.
    Rabin C, Pinto B. Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psychooncology. 2006;15(8):701–12.PubMedGoogle Scholar
  111. 111.
    Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH. Home-based physical activity intervention for breast cancer patients. J Clin Oncol. 2005;23(15):3577–87.PubMedGoogle Scholar
  112. 112.
    von Gruenigen VE, Gibbons HE, Kavanagh MB, Janata JW, Lerner E, Courneya KS. A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change. Health Qual Life Outcomes. 2009;7:17.Google Scholar
  113. 113.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.PubMedGoogle Scholar
  114. 114.
    Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997.Google Scholar
  115. 115.
    Vallance JK, Courneya KS, Plotnikoff RC, Yasui Y, Mackey JR. Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol. 2007;25(17):2352–9.PubMedGoogle Scholar
  116. 116.
    Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J. Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nurs Res. 2007;56(1):18–27.PubMedGoogle Scholar
  117. 117.
    Boesen EH, Ross L, Frederiksen K, Thomsen BL, Dahlstrom K, Schmidt G, et al. Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol. 2005;23(6):1270–7.PubMedGoogle Scholar
  118. 118.
    Lane LG, Viney LL. The effects of personal construct group therapy on breast cancer survivors. J Consult Clin Psychol. 2005;73(2):284–92.PubMedGoogle Scholar
  119. 119.
    Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J, et al. Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology. 2005;14(11):962–78.PubMedGoogle Scholar
  120. 120.
    Bloom JR, Stewart SL, D’Onofrio CN, Luce J, Banks PJ. Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change? J Cancer Surviv. 2008;2(3):190–204.PubMedGoogle Scholar
  121. 121.
    Gilbert SM, Miller DC, Hollenbeck BK, Montie JE, Wei JT. Cancer survivorship: challenges and changing paradigms. J Urol. 2008;179(2):431–8.PubMedCentralPubMedGoogle Scholar
  122. 122.
    Earle CC. Cancer survivorship research and guidelines: maybe the cart should be beside the horse. J Clin Oncol. 2007;25(25):3800–1.PubMedGoogle Scholar
  123. 123.
    Ayanian JZ, Jacobsen PB. Enhancing research on cancer survivors. J Clin Oncol. 2006;24(32):5149–53.PubMedGoogle Scholar
  124. 124.
    OpenClinical. Clinical practice guidelines [Internet]. 2008 [cited 2010 Apr 10]. Available from: [accessed April 10, 2010].
  125. 125.
    Children’s Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers, version 2.0 [Internet]. 2008 [cited 2010 Apr 9]. Available from:
  126. 126.
    Smith TJ, Hillner BE. Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways. J Clin Oncol. 2001;19(11):2886–97.PubMedGoogle Scholar
  127. 127.
    Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091–7.PubMedGoogle Scholar
  128. 128.
    Association of Community Cancer Centers (ACCC). Cancer Program Guidelines [Internet]. 2008 [2010 Apr 8]. Available from:
  129. 129.
    Brown J, Byers T, Thompson K, Eldridge B, Doyle C, Williams AM. Nutrition during and after cancer treatment: a guide for informed choices by cancer survivors. CA Cancer J Clin. 2001;51(3):153–87.PubMedGoogle Scholar
  130. 130.
    Smith TJ, Davidson NE, Schapira DV, Grunfeld E, Muss HB, Vogel III VG, et al. American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines. J Clin Oncol. 1999;17(3):1080–2.PubMedGoogle Scholar
  131. 131.
    Bast Jr RC, Ravdin P, Hayes DF, Bates S, Fritsche Jr H, Jessup JM, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19(6):1865–78.PubMedGoogle Scholar
  132. 132.
    Desch CE, Benson III AB, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol. 2005;23(33):8512–9.PubMedGoogle Scholar
  133. 133.
    American Society of Clinical Oncology. Oncologist-approved cancer information from the American Society of Clinical Oncology [Internet]. 2010 [cited 2010 Apr 9]. Available from:
  134. 134.
    National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology [Internet]. 2010 [cited 2010 Apr 10]. Available from:
  135. 135.
    Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010(40):25–30.PubMedCentralPubMedGoogle Scholar
  136. 136.
    Cooper GS, Johnson CC, Lamerato L, Poisson LM, Schultz L, Simpkins J, et al. Use of guideline recommended follow-up care in cancer survivors: routine or diagnostic indications? Med Care. 2006;44(6):590–4.PubMedGoogle Scholar
  137. 137.
    Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol. 2006;24(32):5112–6.PubMedGoogle Scholar
  138. 138.
    Elston LJ, Simpkins J, Schultz L, Chase GA, Johnson CC, Yood MU, et al. Routine surveillance care after cancer treatment with curative intent. Med Care. 2005;43(6):592–9.Google Scholar
  139. 139.
    Grunfeld E. Primary care physicians and oncologists are players on the same team. J Clin Oncol. 2008;26(14):2246–7.PubMedGoogle Scholar
  140. 140.
    Bober SL, Recklitis CJ, Campbell EG, Park ER, Kutner JS, Najita JS, et al. Caring for cancer survivors: a survey of primary care physicians. Cancer. 2009;115(18 Suppl):4409–18.PubMedGoogle Scholar
  141. 141.
    Cheung WY, Le LW, Zimmermann C. Symptom clusters in patients with advanced cancers. Support Care Cancer. 2009;17(9):1223–30.PubMedGoogle Scholar
  142. 142.
    Miedema B, MacDonald I, Tatemichi S. Cancer follow-up care. Patients’ perspectives. Can Fam Physician. 2003;49:890–5.PubMedCentralPubMedGoogle Scholar
  143. 143.
    Howell D, Hack T, Chulak T, Oliver TK, Mayo S, Aubin M, et al. A Pan-Canadian guidance on adult cancer survivorship services and psychosocial-supportive care clinical practice. Toronto: Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology; 2010.Google Scholar
  144. 144.
    Erikson C, Saisber E, Forte G, Bruinooge S, Goldstein M, et al. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract. 2007;3:79–86.PubMedCentralPubMedGoogle Scholar
  145. 145.
    Grunfeld E, Gray A, Mant D, Yudkin P, Adewuyi-Dalton R, Coyle D, et al. Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation. Br J Cancer. 1999;79(7–8):1227–33.PubMedCentralPubMedGoogle Scholar
  146. 146.
    Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. CMAJ. 2000;163(2):166–9.PubMedCentralPubMedGoogle Scholar
  147. 147.
    Del Giudice ME, Grunfeld E, Harvey BJ, Piliotis E, Verma S. Primary care physicians’ views of routine follow-up care of cancer survivors. J Clin Oncol. 2009;27(20):3338–45.PubMedGoogle Scholar
  148. 148.
    Grunfeld E, Mant D, Vessey MP, Fitzpatrick R. Specialist and general practice views on routine follow-up of breast cancer patients in general practice. Fam Pract. 1995;12(1):60–5.PubMedGoogle Scholar
  149. 149.
    Mao JJ, Bowman MA, Stricker CT, DeMichele A, Jacobs L, Chan D, et al. Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J Clin Oncol. 2009;27(6):933–8.PubMedGoogle Scholar
  150. 150.
    Grunfeld E. Looking beyond survival: how are we looking at survivorship? J Clin Oncol. 2006;24(32):5166–9.PubMedGoogle Scholar
  151. 151.
    Horning SJ. Follow-up of adult cancer survivors: new paradigms for survivorship care planning. Hematol Oncol Clin North Am. 2008;22(2):201–10. v.PubMedGoogle Scholar
  152. 152.
    Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med. 2008;23(3):254–9.PubMedCentralPubMedGoogle Scholar
  153. 153.
    Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol. 2008;26(7):1073–9.PubMedGoogle Scholar
  154. 154.
    Earle CC, Burstein HJ, Winer EP, Weeks JC. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol. 2003;21(8):1447–51.PubMedGoogle Scholar
  155. 155.
    Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer. 2004;101(8):1712–9.PubMedGoogle Scholar
  156. 156.
    Grunfeld E, Fitzpatrick R, Mant D, Yudkin P, Adewuyi-Dalton R, Stewart J, et al. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Pract. 1999;49(446):705–10.PubMedCentralPubMedGoogle Scholar
  157. 157.
    Grunfeld E, Mant D, Yudkin P, Adewuyi-Dalton R, Cole D, Stewart J, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996;313(7058):665–9.PubMedCentralPubMedGoogle Scholar
  158. 158.
    Nissen MJ, Beran MS, Lee MW, Mehta SR, Pine DA, Swenson KK. Views of primary care providers on follow-up care of cancer patients. Fam Med. 2007;39(7):477–82.PubMedGoogle Scholar
  159. 159.
    Starfield B, Fryer Jr GE. The primary care physician workforce: ethical and policy implications. Ann Fam Med. 2007;5(6):486–91.PubMedCentralPubMedGoogle Scholar
  160. 160.
    Salsberg E, Grover A. Physician workforce shortages: implications and issues for academic health centers and policymakers. Acad Med. 2006;81(9):782–7.PubMedGoogle Scholar
  161. 161.
    Salsberg ES, Forte GJ. Trends in the physician workforce, 1980–2000. Health Aff Millwood. 2002;21(5):165–73.PubMedGoogle Scholar
  162. 162.
    Kindig DA. Strategic issues for managing the future physician workforce. Baxter Health Policy Rev. 1996;2:149–82.PubMedGoogle Scholar
  163. 163.
    Goodman DC, Fisher ES. Physician workforce crisis? Wrong diagnosis, wrong prescription. N Engl J Med. 2008;358(16):1658–61.PubMedGoogle Scholar
  164. 164.
    Potter J, Johnston K. Keeping up with survivors: education across the spectrum of cancer. J Gen Intern Med. 2009;24 Suppl 2:S501–2.PubMedGoogle Scholar
  165. 165.
    McCabe MS, Jacobs L. Survivorship care: models and programs. Sem Oncol Nurs. 2008;24(3):202–7.Google Scholar
  166. 166.
    Nekhlyudov L. “Doc, should I see you or my oncologist?”: a primary care perspective on opportunities and challenges in providing comprehensive care for cancer survivors. J Clin Oncol. 2009;27(15):2424–6.PubMedGoogle Scholar
  167. 167.
    Institute of Medicine. Implementing cancer survivorship care planning. Washington, DC: National Academics Press; 2007.Google Scholar
  168. 168.
    Ganz PA, Hahn EE. Implementing a survivorship care plan for patients with breast cancer. J Clin Oncol. 2008;26(5):759–67.PubMedGoogle Scholar
  169. 169.
    CJAP. A brief review of survivorship programs in the United States and Canada. In: Keal S, editor. Cancer Journey Action Group; 2009, pp. 1–23.Google Scholar
  170. 170.
    Canadian Partnership Against Cancer. Cancer journey: boosting integrated person-centred care [Internet]. 2009 [cited 2010 Apr 6]. Available from:
  171. 171.
    Rowland JH. What are cancer survivors telling us? Cancer J. 2008;14(6):361–8.PubMedGoogle Scholar
  172. 172.
    Geiger AM, Strom SS, Demark-Wahnefried W, Buist DS. Strategies to maximize the competitiveness of cancer survivorship grant applications: a report from the American Society of Preventive Oncology’s Survivorship Interest Group. Cancer Epidemiol Biomark Prev. 2008;17(10):2899–900.Google Scholar
  173. 173.
    Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol. 2007;46(4):417–32.PubMedGoogle Scholar
  174. 174.
    Buchanan DR, O’Mara AM, Kelaghan JW, Minasian LM. Quality-of-life assessment in the symptom management trials of the National Cancer Institute-supported Community Clinical Oncology Program. J Clin Oncol. 2005;23(3):591–8.PubMedGoogle Scholar
  175. 175.
    Newell SA, Sanson-Fisher RW, Savolainen NJ. Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst. 2002;94(8):558–84.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Princess Margaret HospitalUniversity Health Network and University of TorontoTorontoCanada

Personalised recommendations