Personalised cancer follow-up: risk stratification, needs assessment or both?

Abstract

First paragraph: There are approximately 2 million people now living with or beyond cancer in the UK (Maddams et al, 2009) and this number is increasing. Cancer survivors can experience physical, psychological and social consequences as a result of the disease and the treatments received (Jefford et al, 2008; Foster et al, 2009). The effects may be immediate, some of which will resolve and others may persist and become long-term. Late effects can also occur and the interval between the end of treatment and onset can range from a few weeks (e.g. lymphoedema after axillary node removal) to several years (e.g. heart disease following radiotherapy to the chest area). Problems will be individual to each patient due to a unique combination of circumstances including the site and stage of the cancer, the type of treatment(s) given, the age of the patient, genetic factors, concomitant co-morbidities, family and social circumstances, and personality traits

Unmet psychosocial needs in haematological cancer: a systematic review

“…There were no studies identified in either sample group that looked at needs in the follow-up care phase, meaning that there is no research evidence looking at long term unmet needs in patients with haematological cancer; with the growing importance of cancer survivorship, this gap in the literature needs to be addressed [3]. There are some similarities when studies are grouped according to diagnosis and time-point, however, no single group contains more than six studies.…”

“…For the purposes of this review, an unmet psychosocial need is defined as the desire or requirement for help or support that, where not provided, may negatively impact upon a person's emotional and psychological wellbeing [3,4]. Included papers were required to state that they were measuring need, rather than simply patient concern, as concern does not necessarily equate to a desire for assistance to meet that need.…”

“…Accordingly, care should no longer focus solely on delivery of medical treatment but also look to encompass the person's psychological Psychosocial needs relate to a desire or requirement for help or support that underlies a person's emotional and psychological wellbeing [3,4].…”

‘They’re survivors physically but we want them to survive mentally as well’: health care professionals’ views on providing potential late effect information

“…The Survivorship Sub-group of the National Cancer Research Institute Primary Care Clinical Studies Group recently proposed a framework for risk stratification [25]. They offer a definition of risk stratification as 'the process of quantifying the probability of a harmful effect to individuals resulting from a range of internal and external factors (e.g., demographic characteristics, genetic make-up, medical treatments) and propose that only those long-term and late effects which meet a pre-determined criteria qualify for risk stratification.…”

Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 The factors which influence poor quality of life (QoL) outcomes in people with HNC become increasingly important as healthcare systems consider how best to utilise finite resources in the follow-up care of a growing number of survivors. The concept of risk stratification has attracted much attention in the context of survivorship care, as it provides a means of quantifying the probability of adverse outcomes in a patient group, and suggests which patients are likely to be at particular risk of poor outcomes, therefore enabling health care professionals to intervene appropriately [13]. Some predictors of poor QoL have been identified including feeding tubes [14] pre-treatment QoL, comorbidity and stage [15].…”