Survivorship Issues for Patients With Lung Cancer

Christie L. Pratt Pozo, DHSc; Mary Ann A. Morgan, PhD; Jhanelle E. Gray, MD


Cancer Control. 2014;21(1):40-50. 

In This Article

Overview of Cancer Survivorship

The term cancer survivorhas many definitions, but the most accepted definition includes from day of diagnosis to end of life and may involve family members and caregivers.[14–17] This differs from the traditional 5 years to be considered a survivor,which is now considered to be an "archaic" definition.[17] Thus, with the lower extended survival rates for lung cancer, this definition is more inclusive and appropriate for survivors of lung cancer as well as their loved ones. Paying attention to their physical and psychological status, dealing with uncertainty and QOL issues, and providing and anticipating supportive care may be crucial for those living with and beyond a cancer diagnosis.[14] It may move a patient from identifying oneself as a victim (helpless, somebody harmed) to a survivor (potential to be someone with powers of endurance or one who manages to grow despite hardship).[18]

As a pediatrician and survivor of cancer, Mullan[19] attempted to identify seasons rather than stages of survivorship as he personally went through the cancer experience. He labeled these as (1) acute season, when the patient undergoes diagnosis and treatment, (2) extended survivorship, when the patient may be cured, in remission, on maintenance therapy, or receiving palliative care, and (3) permanent survivorship (long-term survival or presumed cured).

In 2006, the Institute of Medicine (IOM) published a report[16,20] that included 10 recommendations addressing cancer survivorship as a distinct phase of cancer care. The report also defined long-term consequences from treatment or potential late effects from treatment that are unique to cancer survivors, including effects that develop as a result of treatment and that may linger as time goes on. Late effects are also those that may not surface until years after active treatment has been completed. These long-term and late effects of cancer and its treatment may interfere with the ability to function and perform daily activities, and they may include neuropathies, fatigue, pain, cardiovascular issues, lymphedema, depression, sexual dysfunction, cognitive and functional decline, organ failure and damage, secondary malignancies, and cancer recurrence.[21,22]

In 2010, Miller et al[23] updated the seasons of survival paradigm. After the acute season, they incorporated the idea of transition: patients who try to adjust to a new "normal" or those in a transitional phase. They then distinguished extended survivorship as having 3 trajectories: remission, cancer free, or living with cancer. Within this framework, symptoms may appear, disappear, and reappear over time. In addition, they addressed long-term or late effects of cancer and its treatment, as well as second cancers or secondary cancers from treatment consistent with the 2006 IOM reports.[16,20]