Cancer Survivorship: A Review of Strategies for Optimizing Patient Outcomes

The news on cancer survivorship has been mixed over the past 10 years. Although rates of death have gone down for most cancer sites, they have increased for others.¹

For men, deaths from prostate and stomach cancers decreased, but they increased for cancers of the oral cavity and pharynx, soft tissue including the heart, brain and nervous system, pancreas, and melanoma.¹  

For women, deaths declined for the 3 most common cancers — breast, lung, and colorectal. However, deaths from cancers of the uterus, brain and nervous system, liver, soft tissue including the heart, and pancreas have increased. Deaths among women with cancer of the oral cavity and pharynx remained stable.¹  

Lung cancer deaths have declined by 4.8% per year among men and 3.7% per year among women. Despite this, lung cancer is still the leading cause of cancer death for both groups, accounting for approximately 25% of all cancer deaths.¹

Over the past decade, Oncology Nurse Advisor has presented research on the cancer survivorship issues that patients look to oncology nurses for help with, ranging from adverse effect management, coping with being the atypical patient, and understanding treatment options. As part of our 10-year anniversary celebration, the editors revisited some of those reports and updated those earlier findings with the findings from more current studies.

Cancer-Related Fatigue

As more people survive cancer, more recognition has been given to the difficulties of living with the disease. A June 2010 article on cancer related fatigue (CRF) covered theories as to cause and suggested exercise, counseling, and medication to alleviate it.

Update The current philosophy is that patients with all levels of CRF deserve to have their fatigue addressed through education, counseling, and other modalities. Current treatment trends include exercise, yoga, physiotherapy, and sleep therapy, as well as dietary interventions. Clinicians may also consider prescribing psychostimulants or antidepressants when CRF is accompanied by depression.²

Depression

The effects of depression on physical disease could predict the patient’s outcome (August 2010). Mortality in patients who exhibited symptoms of depression was up to 26% higher than in those who did not have symptoms. This has not changed.

Update A 2018 study reported that “depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anticancer treatment, suicide risk, and likely even the mortality rate for the cancer itself.”³ The authors conclude that more studies and treatment of depression in cancer patients with and without symptoms are needed.

Lymphedema

Weight lifting seemed to be a controversial therapy for reducing the risk of developing lymphedema after breast surgery in January 2011. However, this study showed that breast cancer survivors could benefit from participating in weight lifting programs.

Update The news is even better now. A 2019 study prospectively evaluated the beneficial effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer. The exercise does not increase risk of lymphedema.⁴