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Cancer Survivorship Supplement

CDC’s Division of Cancer Prevention and Control sponsored a special supplement in the American Journal of Preventive Medicine entitled, Addressing Cancer Survivorship Through Public Health Research, Surveillance, and Programs. About 14.5 million men, women, and children are living after being diagnosed with cancer in the United States. Cancer survivors often face physical, emotional, social, and financial challenges as a result of their diagnosis and treatment. The public health community has an essential role in addressing their needs. Public health interventions can reduce cancer recurrence, second cancers, and treatment side effects or consequences, improving survivors’ quality of life.

This collection of articles adds to the existing cancer survivorship literature by offering new research findings, information on surveillance and programmatic activities, and an overview of other work conducted by CDC and its partners over the past decade to identify and address the needs of cancer survivors.

Key Messages

The Public Health Action Model for Cancer Survivorship can help stakeholders achieve better outcomes for survivors.

  • The model serves as a roadmap to guide efforts by cancer survivors and their families, health organizations, community advocates and programmers, policy makers, and others.
  • The model provides a framework for meeting Healthy People 2020 objectives to increase the percentage of survivors who live five years or longer after their diagnosis, and to improve survivors’ mental and physical health.
  • To reach these objectives, we must improve survivors’ physical, social, emotional, and financial well-being.
  • Public health organizations have an important role in developing approaches at multiple levels, from interventions for survivors to changes in health systems policy, to improve overall health and quality of life for cancer survivors and their families.
Public Health Action Model for Cancer Survivorship

The Public Health Action Model for Cancer Survivorship is based on the foundation principles of behavioral change, dissemination and implementation, and evaluation. It works on five levels: the personal level (individual survivors), as well as interpersonal, organizational, community, and policy levels. Levers include access to high-quality medical care and services; surveillance and applied research; programs, policies, and infrastructure; and communication, education, and training. Its drivers are collaborative, evidence-based, culturally aware, and innovative. Its goal is to meet the Healthy People 2020 objectives regarding cancer survivors’ mental and physical health and the proportion of survivors who live five years or longer after diagnosis.

Access to health care is an important issue for cancer survivors.

  • Not all cancer survivors have equal access to medical care. Public health organizations can help provide equal access to important services among all survivors.
  • Cancer survivors may face higher out-of-pocket medical costs than people who have never been diagnosed with cancer. These extra costs can prevent or delay access to important medical care, including cancer screening tests.

Breast cancer survivors need greater support for issues with memory, thinking, and attention.

Many breast cancer survivors (60%) report concerns with memory, thinking, and attention after treatment, but few are talking to their doctors about their needs and concerns, and fewer are receiving treatment to address their concerns.

Colorectal cancer survivors need to be advised to limit alcohol use.

Most colorectal cancer survivors follow dietary recommendations to choose low-fat foods, but few have been told to limit alcohol intake. Most feel supported by their families to eat fruits and vegetables, but half do not feel supported to limit their alcohol intake.

Physical activity may improve colorectal cancer survivors’ quality of life.

Colorectal cancer survivors who exercise may have better physical health and overall quality of life. Room for greatest improvement was in mental health, which may indicate a greater need to screen for emotional and psychological distress routinely.

Surveillance and research are important to improving care for cancer survivors.

CDC’s National Program of Cancer Registries collects data on cancer diagnosis and treatment for 96% of the U.S. population. These data can help patients and their doctors.

There are examples of effective public health interventions to support cancer survivors.

  • CDC-supported comprehensive cancer control programs in New Mexico, South Carolina, Vermont, Washington, and Fond Du Lac Band of Superior Chippewa use evidence-based activities to support target populations of cancer survivors.
  • To address a lack of information tailored for young African-American breast cancer survivors, public health researchers developed the Young Sisters Initiative: A Guide to a Better You! program. This online resource provides social, emotional, and reproductive health information to women navigating breast cancer diagnosis, treatment, and follow-up care.

Articles in Supplement

Introduction

Buchanan ND, Houston K, Richardson LC. The essential role of public health in preventing disease, prolonging life, and promoting health of cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S467–S469.

Survivorship Public Health Model

Moore AR, Buchanan ND, Fairley TL, Smith JL. The public health action model for cancer survivorship. American Journal of Preventive Medicine 2015;49(6S5):S470–S476.

Research and Surveillance

Smith JL, Hall IJ. Advancing health equity in cancer survivorship: opportunities for public health. American Journal of Preventive Medicine 2015;49(6S5):S477–S482.

Hall IJ, Smith JL. Evolution of a CDC public health research agenda for low risk prostate cancer. American Journal of Preventive Medicine 2015;49(6S5):S483–S488.

Guy GP Jr., Yabroff KR, Ekwueme DU, Virgo KS, Han X, Banegas M, Soni A, Sheng Z, Chawla N, Geiger AM. Health care expenditure burden among nonelderly cancer survivors in the United States, 2008–2012. American Journal of Preventive Medicine 2015;49(6S5):S489–S497.

Buchanan ND, Dasari S, Rodriguez JL, Smith JL, Hodgson ME, Weinberg CR, Sandler DP. Post-treatment neurocognition and psychosocial care among breast cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S498–S508.

Hawkins NA, Berkowitz Z, Rodriguez JL. Awareness of dietary and alcohol guidelines among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S509–S517.

Rodriguez JL, Hawkins NA, Berkowitz Z, Li C. Factors associated with health-related quality of life among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S518–S527.

Ryerson AB, Eheman C, Styles T, Rycroft R, Snyder C. Connecting the dots: linking the National Program of Cancer Registries and the needs of survivors and clinicians. American Journal of Preventive Medicine 2015;49(6S5):S528–S535.

Programs and Evaluation

Underwood JM, Lakhani N, Finifrock D, Pinkerton B, Johnson KL, Mallory SH, Santiago PM, Stewart SL. Evidence-based cancer survivorship activities for comprehensive cancer control. American Journal of Preventive Medicine 2015;49(6S5):S536–S542.

Johnson-Turbes A, Schlueter D, Moore AR, Buchanan ND, Fairley TL. Evaluation of a Web-based program for African-American young breast cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S543–S549.

Concluding Commentary

White MC, Hayes N, Richardson LC. Public health’s future role in cancer survivorship. American Journal of Preventive Medicine 2015;49(6S5):S550-S553.

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