Cancer Survivorship and Palliative Care?

I'll give you my strength if I can have your remission.

—John Green, The Fault in Our Stars

Dear Editor:

Denise had survived chemotherapy, radiation, repeated surgeries, and a rectal abscess. She was now a cancer survivor.

But all was not well.

While thankful for the respite of survival, survivorship came with a burden—uncertainty and the fear of recurrence. Remission had turned Denise's life into episodes of worry coupled with traumatic remembrances of treatment. The fear of recurrent cancer controlled her life.

Unfortunately, what Denise experienced is not uncommon. Survivorship with a fear of cancer recurrence (FCR) is one of the greatest unmet needs of cancer patients. In fact, there appears to be no calendar boundaries for the development of FCR—it can occur years after initial diagnosis.^1,2 And with a revised model of cancer survivorship that now includes long-term disease-free survival, ³ the incidence of FCR will only increase. ⁴

Since survivorship programs are not universally available, primary care providers will likely be the caregivers for most of these patients, but should palliative care be part of the team? I would argue yes. Admittedly, the definition of palliative care has been confined to treatment of patients with a life-threatening or terminal illness; however, patients with FCR frequently exhibit symptoms that palliative care clinicians see and evaluate on a daily basis, including pain, nausea/vomiting, neuropathy, anxiety, depression, and anorexia. I believe palliative care would bring much to the therapeutic table by helping to manage the complexities of the physical and mental health of cancer survivors, including late complications of cancer treatment, and in so doing, improve functioning and well-being of survivors and their families. ⁵