Breast cancer survivors account for 23% of the more than 10 million cancer survivors in the United States today. The treatments for breast cancer are complex and extend over a long period of time. The post-treatment period is characterized by gradual recovery from many adverse effects from treatment; however, many symptoms and problems persist as late effects (eg, infertility, menopausal symptoms, fatigue), and there may be less frequent long-term effects (eg, second cancers, lymphedema, osteoporosis). There is increasing recognition of the need to summarize the patient's course of treatment into a formal document, called the cancer treatment summary, that also includes recommendations for subsequent cancer surveillance, management of late effects, and strategies for health promotion. This article provides guidance on how oncologists can implement a cancer treatment summary and survivorship care plan for breast cancer survivors, with examples and linkage to useful resources. Providing the breast cancer treatment summary and survivorship care plan is being recognized as a key component of coordination of care that will foster the delivery of high-quality cancer care.
Increasing national attention focuses on the specialized needs of disease-free survivors of cancer. 1-5 This is a direct reflection of the growing number of survivors of cancer in the US, currently estimated at almost 12 million, 6 and the many challenges of delivering optimal health care to these individuals. The health system will be further stressed by the aging of the US population during the next 25 years and the corresponding increase in long-term survivors. Most cancers are diagnosed in older adults who have preexisting comorbid conditions that are exacerbated by cancer treatment. The convergence of preexisting and new chronic conditions in older survivors of cancer is a major challenge for health care policy and delivery. To meet this challenge, we must develop a model of care delivery to maximize the health and well-being of survivors of cancer, focusing on effective symptom management, prevention of late effects, and health promotion. It is time to revitalize the link between cancer survivorship and cancer rehabilitation and investigate a new model of comprehensive cancer rehabilitation, involving a multidisciplinary team of providers that aims to optimize the patient's physical, psychologic, vocational, and social functioning given the limits imposed by the chronic or late effects of cancer treatment and other comorbid conditions.
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