Thanks to significant advances in cancer treatment and improvements in early detection, the number of cancer survivors in the U.S. is growing rapidly. There are over 66,000 cancer survivors in Idaho. Today, a diagnosis of cancer is no longer a death sentence. Patients are living longer with the disease and are frequently disease free. Cancer survivors are now dealing with cancer as a chronic illness or with the chronic side effects of treatment. The growing number of cancer survivors has created a shift in modern cancer care that has an increased focus on quality of life for survivors both during and after treatment. This includes a focus on physical health as well as mental health throughout the continuum of care. Oncologists are encouraged to engage their patients in shared decision making as it relates to issues of survivorship and long term disease management or palliation.

The National Comprehensive Cancer Network (NCCN) published clinical best practice guidelines for survivorship in 2013. In 2014 the American Society for Clinical Oncology (ASCO) followed suit. Both organizations have also published guidelines for palliative care and symptom management that are readily used in cancer care today. The guidelines highlight the important interface between physical health and mental health with special attention to not only disease surveillance and pain management but also assessment and referral for anxiety, depression, sexual function, nutrition and physical activity. A growing body of research supports the inclusion of these issues as part of the quality of life discussion with patients both during and after treatment for cancer. Survivorship is the process of living with, through or beyond cancer.

The Institute of Medicine recommends that every patient receive a survivorship care plan. The Commission on Cancer requires all accredited cancer centers to offer these care plans to patients upon completion of cancer treatment. These care plans must be comprehensive in nature and meet all of the minimum requirements set forth by ASCO.

In addition to the new guidelines and recommendations for survivorship care, there is an increasing effort to improve palliative care programs and access to hospice services for cancer patients with high symptom burden and/or limited life expectancy. The published clinical guidelines for palliative care and symptom management should guide this care. Efforts to improve the quality of life of cancer patients should be accompanied by discussions about advanced care planning and include the implementation of an advanced directive for every patient. These discussions are often difficult to conduct and require that clinicians and staff be trained and comfortable with the subject. Staff should be able to answer questions and direct patients to reputable community resources and organizations.

With the growing number of cancer survivors in Idaho, healthcare providers, community organizations, researchers, health plan administrators and advocates must be prepared to meet the unique and often challenging needs of this population. With the landscape of healthcare requirements, guidelines and recommendations ever changing, it is important that the CCAI offer an opportunity for healthcare partners to collaborate and receive the latest education on best practices. There are many different models for providing survivorship and palliative care to improve the quality of life of cancer survivors in Idaho and through collaboration and education this goal can be achieved.