MODULE 1
WELCOME TO MODULE 1 – CANCER SURVIVORSHIP MODULES
Focus
In this module we are going to look at key features of the Cancer Survivorship
Experience and outline the epidemiological profile of cancer survivorship in
Australia. We are also going to look at the importance of incorporating cancer
survivorship care into your every day practice.
Defining cancer survivorship
A variety of definitions of cancer survivorship have emerged in recent years
and the service as an intervention to support the survivor can also vary at the
point of which they are introduced. However common to each definition is the
emphasis on the ongoing unique needs of individuals who have experienced
the diagnosis of cancer. In Australia, survivorship is generally considered to
be the phase after completion of initial treatment and initiatives are generally
focused on meeting needs where gaps have been identified post treatment.
However, the skills necessary to support people to move positively into
survivorship care, can be introduced from diagnosis. While there has been
very active survivorship research, care for this population is evolving and
requires further coordination. In England, the National Cancer Survivorship
Initiative definition recognises that survivorship encompasses those who are
undergoing primary treatment. The focus of this initiative is on the
assessment, care and support given to people from the end of the primary
treatment onwards.
Prevalence of cancer
So how many cancer survivors are there? In Australia, UK and the US about
3% - 4% of the population have had a cancer diagnosis. Worldwide and in
Australia, we are seeing cancer prevalence increasing. Here are some quick
stats: at the end of 2007 in Australia, more than 339,000 people were alive
who had been diagnosed with cancer within the previous 5 years. This
represented 1.6% of the Australian population. The 5 year prevalence was
higher in males than in females and the 26 year prevalence increased with
age, with the highest prevalence among those aged 80 and over. We can
also see from the graph that 19% of all Australians aged 80 and over had had
a diagnosis of cancer within the previous 26 years. This represented
approximately 3.3% of the Australian population.
Survival by type
We have looked at how many cancer survivors there are in Australia. Let’s
consider this graph representing cancer survival rates in Australia, which is
generally high, compared to most other countries. In 2006 - 2010, the 5 year
relative survival for all cancers combined was 66%. Between 1982 -1987 and
2006 – 2010 survival from most cancers improved but the change was not
uniform over time and across cancer types. The major group of cancer
survivors in Australia have each had improvements to survival rates from the
period 1982 – 1987 to 2006 – 2010. In prostate cancer, 92% 5 year survival
rate up from 58%. Breast cancer 89% 5 year survival rate up from 72%.
Melanoma of the skin, 91% 5 year survival rate up from 86%. Bowel cancer
66% 5 year survival rate up from 48%. Lung cancer, 14% 5 year survival rate
up from 8.7%. For men, 5 year relative survival was highest for testicular
cancer at 98%; lip cancer 93% and prostate cancer 92%. For women, 5 year
relative survival is highest for thyroid cancer at 98%; melanoma of the skin at
95%; lip cancer of 92%. We also note the survival rates can vary according to
a range of socio-demographic factors. 5 year relative survival was higher for
people living in the least disadvantaged areas at 71% and lowest for people
living in the most disadvantaged areas at 63%.
Ageing population
The Australian population is ageing. At the 30th June 2011, more than 3
million Australians – that’s 14% of the population – were aged 65 or over. By
2031, older Australians are projected to grow to 19% - 21% of the population.
The number of people aged 85 and over is expected to more than double in
the next two decades. What implications does this epidemiological data have
for survivorship care? Click on the box below to reveal the answer
Experience of a survivor
Being a survivor means different things to different people. Some individuals
report positive psycho-social effects including strength in relationships, a
sense of gratitude or empowerment or an increased appreciation for life.
What do you think are some of the common concerns that have been
identified by survivors?
Common survivor needs
Survivors are at risk of experiencing distress associated with the range of
physical, psychological, social or practical changes associated with
survivorship. At least 50% of survivors suffer from some late effects of cancer
treatment. Click below to reveal a summary of Potential Health Needs for
Cancer Survivors.
Specific issues
Improved survival in some childhood cancers has resulted in a decline in
mortality among children over the past decade. Click on the icon to show
epidemiological data relating to childhood cancers. Common challenges
experienced by child cancer survivors include: impact on growth; development
and intellectual function; the development of second cancers; psycho-social
problems; organ system impairment including cardio vascular disease, renal
dysfunction, severe muscular skeletal problems and endocrine pathologies.
Significantly it has been found that the incidence of chronic health conditions
increases over time and does not appear to plateau. This adds further
evidence to support the continued follow-up of childhood cancer survivors with
an emphasis of surveillance for chronic conditions.
Adolescents and young adults
Common challenges experienced by adolescent and young adult cancer
survivors include: long term physical impacts of cancer and its treatment
which may include fatigue, pain, limb loss, impacts on fertility, cardiac and
respiratory late effects and second malignancies; cognitive change which may
be pronounced in the AYA life cycle which involve significant cognitive and
neurological development; changed identity and challenges to the concepts of
personal and social self uncertainty; anxiety; depression and other emotional
impacts; challenges to body image and sexual identity; changed relationships;
impacts on education and employment and financial and insurance
restrictions. Click on the icon to reveal epidemiological data relating to
adolescent and young adult cancers.
Survival by age
Cancer Survivorship care for the elder population, which we generally refer to
as people 65 years and older, requires that attention be given to the expected
late and long term effects of cancer and cancer treatments; as well as
expected changes in health status that occurs with ageing. The following
factors should be taken into account when assessing the older cancer
survivors; functional status, co-morbidity, cognition, social support, psychosocial state, concomitant medications, nutrition, continence and carer support.
Click to reveal the epidemiological data relating to cancers in older people.
Summary
In summary in this module we have looked at some of key features of cancer
survivorship as an introduction. This has included a review of the
epidemiological profile of cancer survivors in Australia. We have also begun
to look at the health and support needs of cancer survivors as well as special
issues for key population groups. In later modules, we look in more details at
health and support needs of cancer survivors and how you as a clinician can
assist cancer survivors in your care. We will also be looking at the crucial
elements of how survivorship care can be incorporated into routine service
delivery. Please now complete the Module 1 Quiz to test your knowledge.
References 1
The next two slides contain the references that we used for the creation of this
module. Thanks very much for listening.