About this course:
This module aims to provide an overview of cancer survivorship as a standard component of the cancer care continuum, outlining the core components of survivorship care and the importance of ensuring survivors receive high-quality, comprehensive, and coordinated care.
This module aims to provide an overview of cancer survivorship as a standard component of the cancer care continuum, outlining the core components of survivorship care and the importance of ensuring survivors receive high-quality, comprehensive, and coordinated care.
Upon completion of this module, learners should be able to:
- describe the epidemiology of cancer survivors within the US and define the terms “cancer survivor” and “cancer survivorship”
- describe the evolution of cancer survivorship, as well as its purpose and need, and list the core components of survivorship care
- identify the most common needs of cancer survivors, including the long-term and late effects of cancer and its treatment
- review survivorship care plans and guidelines and discuss the importance of care coordination between primary care and specialty providers
According to the Office of Cancer Survivorship (OCS, 2022b), “an individual is considered a cancer survivor from the time of diagnosis through the balance of [his or her] life” (para. 1). This includes those living with cancer, those who are free of cancer, and those who continue to receive treatment to reduce the risk of cancer recurring. The National Coalition for Cancer Survivorship (NCCS) and the American Cancer Society (ACS) have expanded this definition to include the family members, friends, and caregivers of individuals with cancer. Cancer survivorship refers to the period and the process of living with, living through, and living beyond cancer treatment. It encompasses a wide range of experiences and trajectories unique to each individual affected by cancer, centering on their physical, psychological, social, and spiritual health and well-being through the end of life (ACS, 2022; Mayer et al., 2017; NCCS, 2022).
There are an estimated 18.1 million cancer survivors in the US, and this number is expected to rise 24.4% to more than 22.5 million by 2032 and 26 million by 2040. This surge in cancer survivors is attributed to the growth and aging of the population, as well as advancements in cancer screening that allow for early detection and better treatment modalities (ACS, 2022; OCS, 2022a).
In 2022, an estimated 1.9 million people in the US will be diagnosed with cancer. Breast cancer is the most common overall diagnosis, with estimates that 287,850 women and 2,710 men will be diagnosed this year, followed by prostate cancer with 268,490 new cases, and lung and bronchus cancer with 236,740 new cases. The three most prevalent cancer types among males, comprising 43% of all new cancers diagnosed, are prostate (268,490), lung and bronchus (117,910), and colon and rectum (80,690). In contrast, among females, the three most prevalent types, accounting for 50% of all new cancers diagnosed, consist of breast (287,850), lung and bronchus (118,830), and colon and rectum (70,340; National Cancer Institute [NCI], 2022).
The overall cancer mortality rate in the US declined by more than 27% between 2001 and 2020, from 196.5 to 144.1 deaths per 100,000 people (see Figure 1). The Healthy People 2030 goal is to decrease cancer deaths to 122.7 per 100,000 people (see Figure 2). Between 2016 and 2020, the age-adjusted mortality rate decreased by an average of 2.2% per year for men and 2.0% per year for women. Despite these declines, cancer was the second leading cause of death in 2020 and was responsible for 602,350 deaths. Deaths due to heart disease and cancer caused nearly half of all deaths in the US. Cancer is currently the leading cause of death for those under 65. In 2022, approximately 609,360 people will die from cancer in the US. Lung and bronchus cancers are the deadliest, with 130,180 anticipated deaths, followed by colon and rectum cancers, with an estimated 52,580 deaths. Pancreatic cancer is the third deadliest cancer, expected to cause 49,830 deaths (Centers for Disease Control and Prevention [CDC], 2022a; NCI, 2022).
US Cancer Death Rates
Cancer Death Rates by Sex
The most common cancer sites among female survivors are the breast (4 million), uterine corpus (891,560), and thyroid (823,800). The most common cancer sites among male survivors are the prostate (3.5 million), skin (760,640), and colon and rectum (726,450). According to the ACS (2022) report outlining statistics on cancer prevalence and treatment patterns within the US, 69% of survivors (12.5 million) were diagnosed 5 or more years ago, 47% (8.5 million) were diagnosed 10 or more years ago, and 19% (3.3 million) were diagnosed 20 or more years ago. Over the next decade, the number of people alive 5 or more years after an initial cancer diagnosis is projected to increase by 33% to 15.1 million. Two-thirds (67%) of survivors are 65 or older, and it is projected that by 2040, 74% of survivors in the US will likely be 65 years or older. Currently, only 10% of survivors are younger than 50 (ACS, 2022; OCS, 2022a).
For most cancer types, 5-year relative cancer survival has improved over the last several decades. Survival is multifactorial, influenced by several factors that extend beyond the type of cancer. These factors include a patient’s age and stage at diagnosis, comorbid health conditions, performance status, treatment, insurance, access to care, and financial resources. Patient, family, and physician attitudes, beliefs, and goals of care also influence treatment recommendations, options, and care delivery, which in turn impacts survival. Access to high-quality cancer care increases the likelihood of survival, although this is not universally available. Disparities in the stage at diagnosis and treatment impact the outcomes of those in medically underserved populations (Miller et al., 2019).
Evolution of Survivorship Care
The concept of cancer survivorship dates to the mid-1980s when Dr. Fitzhugh Mullan published an article in the New England Journal of Medicine entitled "Seasons of Survival." He identified three phases to describe cancer survivorship: acute (diagnosis and treatment of cancer), extended (the period following treatment), and permanent (primarily focusing on those patients considered "cured" or in remission). The following year, Dr. Mullan joined forces with a group of cancer survivors and founded the NCCS, which strove not only to identify and meet the needs of cancer survivors but also to eradicate the terminology related to cancer victimhood and replace it with “cancer survivor” (Mayer et al., 2017). Dr. Mullan's work has been widely utilized and expanded in recent decades. The NCCS remains the oldest cancer survivor-led advocacy organization in the country, striving to effect policy change nationally (NCCS, 2022).
A patient-centered approach to cancer survivorship is at the forefront of accreditation standards for comprehensive cancer programs as mandated by the Commission on Cancer (CoC) of the American College of Surgeons (ACOS, 2022). There has been a national push toward ensuring survivorship care planning becomes the standard of care for all patients since the Institute of Medicine (IOM) and Nat
...purchase below to continue the course
It has taken more than a decade for cancer survivorship standards to come to fruition, and the need has multiplied as cancer survivors in the US now represent 5% of the population (ACS, 2022). Given the dramatic growth of the cancer-survivorship population and the multifaceted challenges accompanying survivorship, helping cancer survivors live longer and healthier lives is more important than ever (Miller et al., 2019). Some individuals may be cancer-free for the remainder of their life after initial treatment ends. In contrast, others may live with cancer as a chronic disease or experience periods of cancer relapse and recurrence. Some patients may develop a secondary malignancy related to their primary cancer treatment or constitute a new primary cancer. These patients have unique needs, and cancer survivorship strives to fill this critical gap in care (ACS, 2022).
Core Components of Cancer Survivorship
Survivorship encompasses several focal areas, including cancer recurrence, new cancer diagnosis, and secondary malignancies. Care consists of managing the long-term and late effects of treatment, quality of life, economic issues associated with cancer care, and emotional and psychological consequences of a cancer diagnosis, its treatment, and the completion of treatment. Cancer survivorship also encompasses health promotion, cancer screening, prevention, early detection of cancer, and the impact of other chronic and comorbid conditions (Miller et al., 2019). The core components of survivorship care are outlined in Table 1.
The Core Components of Survivorship Care
Prevention of recurrent and new cancers with behavioral lifestyle changes geared toward reducing risk and preventing cancer
Surveillance for the early detection and treatment of cancer spread and recurrence or the development of secondary malignancies
Detection of the long-term and late effects of cancer treatment and evidence-based intervention and management for consequences of cancer and its treatment, including medical and psychosocial effects
Coordination between oncologists, specialists, and primary care providers (PCPs) to ensure all survivors’ health needs are met
Quality of life
Enhancing quality of life as it pertains to well-being across four domains: physical, social, psychological, and spiritual
(ACOS, 2022; ACS, 2022)
Models of Survivorship Care
Cancer survivorship is recognized as a formal part of the cancer care continuum, but the models of survivorship care delivery continue to evolve. Given the uniqueness and personalization of the cancer survivorship journey, each individual faces distinct challenges while navigating this new path. Adjusting to life after cancer is unique and can take an extended time. It is rarely experienced similarly to life before cancer, as many survivors refer to cancer survivorship as their “new normal.” Unmet needs during this transition pose the most significant challenges for cancer survivors. When left unaddressed, they lead to a poorer quality of life, more significant physical impairment, a greater symptom burden, and heightened anxiety and depression. The models for survivorship follow-up care continue to evolve based on the type of cancer, physician preferences and beliefs, resources, geographic location of care, capacity to deliver specific services, and many other influences. Despite the distinctions among survivorship models, cancer survivorship's primary objectives and outcomes are predominantly aligned. The primary focus is on improving the quality of care to enhance long-term health and survival while allowing survivors to achieve their highest quality of life. Table 2 demonstrates a conceptual framework of the quality of life and well-being among cancer survivors and the most common issues faced within each domain (Kline et al., 2018; Mayer et al., 2019).
The 4 Domains of Quality of Life for Cancer Survivors
Pain or distress
Economic and financial issues
Meaning of illness
Nutrition and body mass index (BMI)
Anxiety or depression
Sexuality, reproduction, and infertility
Fear of recurrence
Roles and relationships
Sleep-wake disturbances and fatigue
Body image or appearance
Hope or hopefulness
Long-term and latent cardiopulmonary, neurologic, skin, and endocrine effects*
Cognition, attention, and memory changes
Isolation and social support
*To be discussed later in the module (Mayer et al., 2019)
Comorbid Conditions in Cancer Survivors
Cancer survivorship literature demonstrates that physical inactivity, poor nutrition, and resulting obesity are the most critical risk factors—aside from tobacco use—for cancer recurrence, morbidity, and premature death after curative treatment for cancer (Basen-Engquist et al., 2018). Cancer survivors suffer from many comorbid conditions even after their cancer is treated. The most common comorbid conditions in cancer survivors include:
- non-insulin-dependent diabetes mellitus (NIDDM)
- coronary artery disease (CAD)
- depression and cognitive changes
- osteopenia/osteoporosis (Mayer et al., 2017; Roy et al., 2018)
Long-Term and Late Effects of Cancer and Cancer Treatment
An estimated 25% of cancer survivors report a decreased quality of life due to the physical effects and 10% due to the emotional impact of their cancer or cancer treatment (ACS, 2022). Long-term effects of cancer and cancer treatment refer to the side effects or complications that linger after treatment ends, involve all body systems, and affect all health aspects. They generally begin during treatment and continue beyond treatment completion. Late (latent) effects may comprise unrecognized complications or side effects that are absent or subclinical at the end of treatment and can occur for months to years after treatment has ended (American Society of Clinical Oncology [ASCO], 2021). Long-term and latent effects largely depend on the type of cancer, treatment received, preexisting conditions, underlying health problems, and any treatment-related complications. Effects can be related to chemotherapy, surgery, radiation, hormonal therapy, or a combination of any of these; alternatively, effects may be entirely nonspecific. Some of the most reported long-term and latent effects based on treatment modality are summarized as follows (Gegechkori et al., 2017; Kline et al., 2018):
- Surgical effects are generally site-specific and may include body image concerns (body dysmorphia), lymphedema, scarring, urinary or fecal incontinence, erectile dysfunction, and chronic pain.
- Radiation therapy effects are site-specific and can include lymphedema, hypothyroidism, skin discoloration, pulmonary toxicity, atherosclerosis, risk for skin cancer at previously treated sites, pericardial disease, and pain. Patients who received cervical or prostate radiation or radiation to the bowel for gastrointestinal malignancies may endure long-term bowel dysfunction from radiation proctitis. Radiation proctitis is inflammation and damage to the lower parts of the colon, and symptoms often mimic irritable bowel syndrome with persistent abdominal pain, chronic diarrhea, and bloody stools. Patients may also endure the loss of anal sphincter tone leading to fecal incontinence and are at heightened risk for developing an anal or a rectovaginal fistula (i.e., an abnormal connection between hollow spaces).
- Chemotherapy effects are drug- and dose-specific and can include sexual dysfunction such as decreased libido, infertility, and dyspareunia (difficult or painful sexual intercourse). The heart may become damaged from specific cardiotoxic chemotherapeutic agents, leading to cardiomyopathy or heart failure. The lungs can become damaged from specific pulmonary toxic chemotherapeutic agents, leading to pulmonary fibrosis, lung scarring, decreased lung function, and chronic respiratory symptoms. Many patients experience long-term neurological deficits, including cognitive dysfunction, peripheral neuropathy, and neuromuscular impairments (loss of deep tendon reflexes). Some chemotherapy agents may increase a patient's risk of developing secondary malignancies several years later.
- Hormonal therapy is commonly administered over extended periods and often contributes to several ongoing and lasting side effects. For many estrogen-receptor-positive breast cancers, hormonal treatment may continue for 5 to 10 years. These effects can include premature menopause and accompanying vasomotor symptoms such as hot flashes and night sweats. Other effects include arthralgia (joint pain), vaginal atrophy leading to vaginal dryness and dyspareunia (painful intercourse), mood changes, weight gain, bone loss (osteopenia or osteoporosis), and hyperlipidemia. In males, hormonal treatment can induce hot flashes and sexual dysfunction, including erectile dysfunction and loss of libido.
- Non-treatment-specific long-term and late effects can include chronic fatigue or psychosocial and emotional alterations, such as depression, anxiety, and distress (emotional, financial, and spiritual).
Survivorship Care Plans
Survivorship care plans can be compared to discharge planning for hospitalized patients, except that survivorship plans are much more extensive. Like discharge planning, which should begin upon admission to the hospital, survivorship care planning should commence at the time of diagnosis and continue throughout treatment (Mayer et al., 2019). Composed of guidelines for monitoring and maintaining health, survivorship care plans seek to improve the quality of care and long-term outcomes for survivors, with recommendations that strongly accentuate the need for survivors to follow cancer monitoring and surveillance standards, maintain a healthy weight, consume a well-balanced diet, avoid tobacco, and engage in regular physical exercise, regardless of tumor type (IOM, 2006). Survivorship care plans include information vital to the patient’s long-term follow-up care. This includes their initial cancer diagnosis, any treatment administered, the known long-term effects of treatment, following physicians, and the timing of follow-up visits or testing. Patients should also be educated on lifestyle changes that promote healthy living and decrease the risk of secondary cancers. Patients should also be given information on support services. The care plan intends to enhance coordination among the extended care team members and improve communication between survivors, their PCP, and oncology specialists. These written documents seek to inform the PCP of all the aspects of care that have transpired to date and ensure continuity of care while offering evidence-based recommendations for surveillance and screening. PCPs are critical in providing follow-up care for cancer survivors and improving the quality of care and outcomes following treatment (ASCO, 2022; CDC, 2022b).
Cancer Survivorship Guidelines
Cancer survivorship guidelines provide a framework for general survivorship care and the management of potential long-term and late effects of cancer and its treatment that survivors may experience (Tevaarwerk et al., 2021). There are different models of cancer survivorship, which vary widely based on the cancer institute's resources, staffing, and financial capabilities. While some organizations can provide fully staffed cancer survivorship programs, others utilize the combined efforts of oncologists and oncology nurse practitioners, along with assistance from oncology nurses or oncology nurse navigators, to facilitate the composition and delivery of survivorship care plans. Ideally, survivorship care should include a transition visit at the end of treatment, in which current symptoms are addressed, the survivorship care plan is reviewed, and the patient is given a copy of their personalized plan. During this visit, education regarding the surveillance and prevention of recurrent cancers should be reviewed, as well as ways to improve health and reduce the risk of new cancers. Each patient should receive education on the potential late effects of treatment, health promotion, a follow-up plan, and resources and referrals as indicated (ASCO, n.d.).
American Society of Clinical Oncology Guidelines
The chance that cancer will recur, and the likely timing and location of a recurrence, depends on the type of cancer initially diagnosed. The goals of a cancer survivorship program, as recommended by ASCO, include the following:
- prevention of recurrent and new cancers
- surveillance for cancer spread or recurrence
- assessment of late medical and psychological effects of therapy
- adherence and interventions for the consequences of cancer and its treatment
- coordination between specialists and other healthcare providers (HCPs; ASCO, n.d.)
ASCO guidelines are constantly evolving. Currently, the guidelines offer symptom-based (i.e., neuropathy, fatigue, anxiety, depression, fertility preservation) and tumor-specific (i.e., breast cancer survivorship care guideline) plans (ASCO, n.d.; Tevaarwerk et al., 2021).
National Comprehensive Cancer Network Guidelines
The National Comprehensive Cancer Network (NCCN) guidelines for survivorship are intended to supplement the follow-up recommendations of the NCCN's disease-specific guidelines. These standards offer specific survivorship assessment tools to screen patients for individualized symptoms and concerns and corresponding expert consensus opinions for managing the identified issue. The management of long-term and latent effects of cancer and its treatment varies based on several factors, such as clinical presentation, the severity of symptoms, and access to care (Tevaarwerk et al., 2021). The NCCN offers specialized algorithms and interventions unique to the key symptoms associated with cancer survivorship:
- cardiac toxicity
- anxiety, depression, trauma, and distress
- cognitive function
- hormone-related symptoms
- sexual function
- sleep disorder
- healthy lifestyle
- immunization and infections (Tevaarwerk et al., 2021)
The guidelines are intended for use by HCPs who work with cancer survivors in the post-treatment period, including those in oncology and primary care practices. They offer comprehensive assessment and management algorithms based on the four domains of quality of life and well-being. There is also an extensive focus on preventative care and routine health maintenance (Tevaarwerk et al., 2021).
American Cancer Society Guidelines
The ACS (2020) survivorship guidelines were constructed to assist PCPs and other clinicians with the clinical care and management of survivors. The ACS currently offers four tumor-specific guidelines (breast, prostate, colorectal, and head and neck). The ACS survivorship guidelines primarily focus on healthy lifestyles, behavioral changes, physical activity, and weight loss among survivors. Obesity is correlated with an increased risk for many cancers and contributes to poor outcomes. The link between obesity and cancer is well established, yet survivorship studies demonstrate that cancer survivors engage in low physical activity levels and rarely adopt lifestyle modifications. Nearly two-thirds of patients gain weight during or after treatment. In response, the ACS has put forth weight management and healthy lifestyle guidelines tailored to the cancer-survivorship population. These guidelines address obesity in the context of a cancer diagnosis, inform patients and HCPs about the link between obesity and cancer, and focus on prevention, exercise, nutrition, and weight management. They highlight diet and physical activity recommendations during the continuum of cancer care but concentrate primarily on the needs of the survivorship population after treatment ends. The ACS guidelines are Level I evidence and are categorized as strong evidence per the Agency for Healthcare Research and Quality (AHRQ)'s National Guideline Clearinghouse database of evidence-based clinical practice. A national panel of experts in cancer research, prevention, epidemiology, public health, policy, nutrition, physical activity, and cancer survivorship convene to review meta-analyses of randomized clinical trials and identify best clinical practices related to optimal lifestyle behaviors after a diagnosis of cancer. Every 5 years, findings are updated and summarized into structured guidelines that serve as tools for HCPs to guide cancer survivors toward healthy lifestyles (ACS, 2020; Haggerty et al., 2017). Table 3 summarizes the main principles of the 2020 ACS guidelines about healthy lifestyle behaviors in cancer survivors.
ACS Nutrition and Physical Activity Guidelines for Cancer Survivors
Achieve and Maintain a Healthy Weight
a one-on-one counseling session with a clinician
structured weight-loss programs
health tracking using online tools or smartphone applications
engaging in regular physical activity
returning to normal daily activities as soon as possible
moderate vs. vigorous activity
cardiovascular exercise at least 150 minutes per week with strength training at least two days per week
limiting consumption of high-calorie foods and beverages
food portion control
a diet high in vegetables, fruits, and whole grains
referral to a registered dietician
limit or avoid alcohol
Barriers to Survivorship Care
There are several barriers to providing high-quality, patient-centered survivorship care, such as sociodemographic characteristics, a lack of training among HCPs, a lack of reimbursement structures and insurance coverage, and the US's fragmented healthcare-delivery system. A significant barrier to receiving timely, appropriate, evidence-based cancer care is insurance coverage, especially for those survivors who are uninsured or underinsured. A lack of reimbursement for survivorship care remains a tremendous problem within the US and compromises survivors' access to and receipt of high-quality care. Most US insurers do not provide additional reimbursement for survivorship care, which often includes psychosocial support and care-planning services. HCPs, particularly oncology specialists and PCPs, must be adequately educated and trained to identify and treat survivorship issues to bridge this gap in care. Unfortunately, not all providers receive adequate training within these domains, which creates a significant obstacle in providing timely, appropriate, and high-quality survivorship care. Electronic health record systems and medical record sharing and tracking limitations amplify communication gaps between oncologists, specialists, and PCPs. Additional barriers include language and health illiteracy, issues with transportation, unemployment, and disability associated with cancer and its treatment (Kline et al., 2018; Miller et al., 2019).
The Critical Role of Nurses in Cancer Survivorship
The oversight of a skilled and knowledgeable HCP is essential as cancer patients transition from active treatment to extended survivorship. While oncologists or nurse practitioners typically conduct survivorship visits, nurses have pivotal roles in survivorship care. Nurses are uniquely positioned to facilitate survivorship care and improve the quality of care and patient outcomes. Nurses have the skills to integrate, coordinate care, and serve as patient educators and advocates. They possess the skills and knowledge to assess and manage treatment-related side effects, provide education regarding the recurrence of symptoms, identify late side effects, and emphasize the importance of adopting healthy lifestyle changes. Nurses must ensure that patients have knowledgeable PCPs who address survivorship needs and coordinate referrals to specialists when needed. A nurse's role in survivorship can also tremendously reduce the communication gap between providers and ensure that cancer survivors are not lost to follow-up (Nettina, 2019).
Cancer Survivorship Resources
- American Cancer Society: http://cancer.org
- American Society of Clinical Oncology: http://www.asco.org
- LIVESTRONG (Lance Armstrong Foundation): www.livestrong.org
- National Comprehensive Cancer Network: www.nccn.org
- National Coalition for Cancer Survivorship: www.canceradvocacy.org
- National Cancer Institute, Office of Cancer Survivorship: https://cancercontrol.cancer.gov/ocs
American Cancer Society. (2020). American Cancer Society guideline for diet and physical activity for cancer prevention. https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html
American Cancer Society. (2022). Cancer treatment & survivorship facts & figures. https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html
American College of Surgeons. (2022). Optimal resources for cancer care: 2020 standards. https://www.facs.org/media/whmfnppx/2020_coc_standards.pdf
American Society of Clinical Oncology. (n.d.). Survivorship compendium. Retrieved September 4, 2022, from https://www.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/survivorship-compendium
American Society of Clinical Oncology. (2021). Cancer survivorship. https://www.cancer.net/sites/cancer.net/files/cancer_survivorship.pdf
American Society of Clinical Oncology. (2022). ASCO cancer treatment and survivorship care plans. https://www.cancer.net/survivorship/follow-care-after-cancer-treatment/asco-cancer-treatment-and-survivorship-care-plans
Basen-Engquist, K., Alfano, C. M., Maitin-Shepard, M., Thomson, C. A., Stein, K., Syrjala, K. L., Fallon, E., Pinto, B. M., Schmitz, K. H., Zucker, D. S., Doyle, C., & Demark-Wahnefried, W. (2018). Moving research into practice: Physical activity, nutrition, and weight management for cancer patients and survivors. National Academy of Medicine Perspectives. Discussion Paper, 1-9. https://doi.org/10.31478/201810g
Centers for Disease Control and Prevention. (2022a). An update on cancer deaths in the United States. https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm
Centers for Disease Control and Prevention. (2022b). Cancer survivorship care plans. https://www.cdc.gov/cancer/survivors/life-after-cancer/survivorship-care-plans.htm
Gegechkori, N., Haines, L., & Lin, J. J. (2017). Long-term and latent side effects of specific cancer types. Medical Clinics of North America, 101(6), 1053-1073. https://doi.org/10.1016/j.mcna.2017.06.003
Haggerty, A. F., Sarwer, D. B., Schmitz, K. H., Ko, E. M., Allison, K. C., & Chu, C. S. (2017). Obesity and endometrial cancer: A lack of knowledge but opportunity for intervention. Nutrition and Cancer, 67(7), 990-995. https://doi.org/10.1080/01635581.2017.1359313
Institute of Medicine. (2006). From cancer patient to cancer survivor: Lost in transition. The National Academies Press. https://doi.org/10.17226/11468
Kline, R. M., Arora, N. K., Bradley, C. J., Brauer, E. R., Graves, D. L., Lundsford, N. B., McCabe, M. S., Nasso, S. F., Nekhlyudov, L., Rowland, J. H., Schear, R. M., & Ganz, P. A. (2018). Long-term survivorship care after cancer treatment - summary of a 2017 national cancer policy forum workshop. Journal of the National Cancer Institute, 110(12), 1300-1310. https://doi.org/10.1093/jnci/djy176
Mayer, D. K., Nasso, S. F., & Earp, J. A. (2017). Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. The Lancet Oncology, 18(1), e11-e18. https://doi.org/10.1016/S1470-2045(16)30573-3
Miller, K. D., Nogueria, L., Mariotto, A. B., Rowland, J. H., Yarbroff, K. R., Alfano, C. M., Jemal, A., Kramer, J. L., & Siegel, R. L. (2019). Cancer treatment and survivorship statistics, 2019. CA: A Cancer Journal for Clinicians, 69(5), 363-385. https://doi.org/10.3322/caac.21565
National Cancer Institute. (2022). SEER cancer stat facts: Common cancer sites. https://seer.cancer.gov/statfacts/html/common.html
National Coalition for Cancer Survivorship. (2022). Our history. https://www.canceradvocacy.org/about-us/our-history/
Nettina, S. M. (2019). Lippincott manual of nursing practice (11th ed.). Wolters Kluwer.
Office of Cancer Survivorship. (2022a). Statistics and graphs. https://cancercontrol.cancer.gov/ocs/statistics
Office of Cancer Survivorship. (2022b). Survivorship terms. https://cancercontrol.cancer.gov/ocs/definitions
Roy, S., Vallepu, S., Barrios, C., & Hunter, K. (2018). Comparison of comorbid conditions between cancer survivors and age-matched patients without cancer. Journal of Clinical Medicine Research, 10(12), 911-919. https://doi.org/10.14740/jocmr3617w
Tevaarwerk, A., Denlinger, C. S., Sanft, T., Ansbaugh, S. M., Armenian, S., Baker, K. S., Broderick, G., Day, A., Demark-Wahnefried, W., Dickinson, K., Friedman, D. L., Ganz, P., Goldman, M., Henry, N. L., Hill-Kayser, C., Hudson, M., Khakpour, N., Koura, D., McDonough, A. L., . . . Freedman-Cass, D. A. (2021). Survivorship, Version 1.2021: Featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network, 19(6), 676-685. https://doi.org/10.6004/jnccn.2021.0028