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

Lung Cancer Survivorship

One of the recommendations from the IOM report was that patients should be provided a survivorship treatment summary and care plan. Ideally, this would be given to patients as they complete the acute phase or season and move on to extended survivorship.[16] This differs from general expectations of communications between generalists and specialists, such as cardiologists providing cardiac testing reports, for the following reasons. The treatment of patients with cancer, including those with lung cancer, is complex, often requiring multiple treatment modalities and specialists such as surgeons, radiation oncologists, and medical oncologists. These treatments may also impact organ systems with immediate complications or have the potential for long-term or late effects. Many patients also have comorbid conditions that may arise during or be affected by their cancer care. For example, compared with the general population, patients with lung cancer have a higher risk of developing a second type of cancer, particularly those with a history of smoking who also have risks for head and neck or urinary tract malignancies.[2,22] Specifically, as a result of tobacco and chemical exposure, survivors of lung cancer are at an increased risk for related diseases such as chronic obstructive pulmonary disease and cardiovascular disease.[24] Patients with lung cancer have a higher severity and prevalence of comorbidities than patients with other types of cancers have, and how these affect survival is inconsistent among studies. However, negative effects for both physical and mental health QOL issues have been reported.[5] Patients with NSCLC who were treated with beta blockers for cardiovascular indications had an overall survival (OS) rate of 22% compared with 13% for patients not taking them.[25] In addition, patients treated with radiation therapy for other malignancies, such as breast cancer or Hodgkin disease, may have an increased risk for a second primary lung cancer. While these secondary malignancies may still occur, they have decreased in incidence with advances in contemporary equipment and radiation treatment dose planning.[26] For patients, a summary of their treatment can provide a plan for their survival and can facilitate coordination with their primary health care professionals,[27] identifying symptoms to report as well as potential long-term or late effects caused by their treatments.

The American Society of Clinical Oncology (ASCO) has developed templates for what should be included in SCLC and NSCLC survivorship treatment summaries and care plans.[28] SCLC and NSCLC cancer survivorship care is also addressed by the National Comprehensive Cancer Network in its 2013 guidelines,[29] including aspects of surveillance and supportive care important to survivors of lung cancer.

In ASCO's Quality Oncology Provider Initiative, the report also included whether patients were given a treatment summary.[30] It is important for health care professionals to note that providing patients who have lung cancer with a survivorship treatment summary and care plan is a standard of care. This was confirmed by the Commission on Cancer,[31] which also incorporated a new standard that psychological distress be assessed at pivotal visits. The National Cancer Institute Community Cancer Programs (NCCCP) are also required to provide lung cancer survivorship programs and care plans.[32]

Barriers do exist regarding the development of treatment summaries and care plans, including time, resources, and issues of electronic health record integration.[33] The health care field will need to develop strategies for the effective incorporation of survivorship plans into the medical records. One model that has been developed is Journey Forward, which is a downloadable program for health care professionals and their patients that provides a survivorship care plan builder when cancer treatments are put into the system.[32] It does not directly interface with the electronic medical record, but it has been used by nurses in community health settings. The templates for ASCO's survivorship care plans and Journey Forward can be accessed at the Web sites listed in Table 1.