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Management of common clinical problems experienced by survivors of cancer
Abstract
Improvements in early detection and treatment have led to a growing prevalence of survivors of cancer worldwide. Models of care fail to address adequately the breadth of physical, psychosocial, and supportive care needs of those who survive cancer. In this Series paper, we summarise the evidence around the management of common clinical problems experienced by survivors of adult cancers and how to cover these issues in a consultation. Reviewing the patient's history of cancer and treatments highlights potential long-term or late effects to consider, and recommended surveillance for recurrence. Physical consequences of specific treatments to identify include cardiac dysfunction, metabolic syndrome, lymphoedema, peripheral neuropathy, and osteoporosis. Immunotherapies can cause specific immune-related effects most commonly in the gastrointestinal tract, endocrine system, skin, and liver. Pain should be screened for and requires assessment of potential causes and non-pharmacological and pharmacological approaches to management. Common psychosocial issues, for which there are effective psychological therapies, include fear of recurrence, fatigue, altered sleep and cognition, and effects on sex and intimacy, finances, and employment. Review of lifestyle factors including smoking, obesity, and alcohol is necessary to reduce the risk of recurrence and second cancers. Exercise can improve quality of life and might improve cancer survival; it can also contribute to the management of fatigue, pain, metabolic syndrome, osteoporosis, and cognitive impairment. Using a supportive care screening tool, such as the Distress Thermometer, can identify specific areas of concern and help prioritise areas to cover in a consultation.
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“This may be related to implementation challenges such as lack of health care professional awareness and training and prioritization of survivorship, organizational barriers including the need for dedicated time slots in clinics to allow for multidisciplinary assessment and management involving a range of subspecialty professionals and supportive care experts, articulation with appropriate referral”
From Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer (2023) · cites this paper as [19]
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Metadata
- Authors
- Emery, J., Butow, P., Lai-Kwon, J., Nekhlyudov, L., Rynderman, M., & Jefford, M.
- Affiliations
- The University of Melbourne (AU)
- The University of Sydney (AU)
- Melanoma Institute Australia (AU)
- Brigham and Women's Hospital (US)
- Peter MacCallum Cancer Centre (AU)
- Corresponding author
- Emery, Jon
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 399
- Issue
- 10334
- Pages
- 1537-1550
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4223950479
- Cited by
- 326
- References
- 98
- Citations by year
- 2026: 88 · 2025: 91 · 2024: 82 · 2023: 47 · 2022: 17
- FWCI
- 7.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council (APP119530)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Keywords
- cancer survivors, late effects of cancer treatment, cardiac dysfunction, metabolic syndrome, lymphedema, peripheral neuropathy, osteoporosis, immune-related adverse events, immunotherapy, cancer pain, fatigue, fear of recurrence, cognitive impairment, secondary malignancies, lifestyle factors, physical activity, Distress Thermometer, supportive care, psychosocial problems
- MeSH terms
- Adult, Fatigue, Humans, Neoplasms, Osteoporosis, Pain, Quality of Life, Survivors, Metabolic Syndrome
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