Quality of Care

In its recent report,1 the Institute of Medicine (IOM) urged as its first recommendation that cancer survivorship be recognized as “a distinct phase of cancer care.” The rationale for this is that until recently cancer survivorship has been relatively neglected in clinical practice, advocacy, and research. By virtue of their sheer numbers and the expected rate of growth of this population, however, the quality of the medical care cancer survivors receive is an increasingly important public health issue. Part of the problem is that there has not been a unifying identity for these patients and the challenges they face. The IOM report strove to address this by defining and highlighting a constellation of long-term and late effects that result from having had cancer treatment: issues around surveillance for and prevention of recurrence and second cancers, long-term and late effects of treatment, psychological sequelae, and social problems such as employment and insurance concerns. Many define a cancer survivor as anyone with a diagnosis of cancer who is still alive. For the purposes of this chapter, however, we will limit the discussion to those aspects of care relevant to the patient who has completed primary therapy for cancer and is currently free of disease, no matter how soon after completion of treatment. The specific problems survivors encounter vary widely from person to person. As a result, it is not possible to define exactly what quality medical care is for a typical survivor. Rather, quality survivor care is rooted in patients having a plan for survivorship. Knowing what was done, what will be done, and who will do it is in many ways more important than the specifics of the recommended plan. The chapter will give an overview of the medical issues adult survivors of cancer may have to deal with as a result of their disease and/or its treatment and will discuss the elements of quality survivor care, organized around the IOM’s recommended “survivorship care plan” (Table 1).