Francesco Atzori Oncologia Medica
AOU-Cagliari
Survivorship Care Plan
Bologna 30 marzo 2017
Management/Prevention of Symptoms and Treatment Toxicities
−Epidemiology of cancer in Italy
−Definition of Survivorship Care Plan
−Survivorship Care Plan in action
−How to build an effective Survivorship Care Plan
−Conclusion
Agenda
−Epidemiology of cancer in Italy
− Definition of Survivorship Care Plan
− Survivorship Care Plan in action
− How to build an effective Survivorship Care Plan
− Conclusion
Agenda
−Nel 2015, 3.037.127 (il 4,9%)
−Nel 2016, 3.136.709 (stime)
−Nel 2006, 2.444.000
Quanti sono gli italiani che vivono dopo una
diagnosi di tumore?
− Epidemiology of cancer in Italy
−Definition of Survivorship Care Plan
− Survivorship Care Plan in action
− How to build an effective Survivorship Care Plan
− Conclusion
Agenda
Who is a cancer survivor?
Any person who . . .
has had a diagnosis of cancer
has completed treatment for cancer
has lived cancer-free 5 years beyond a cancer diagnosis
has a history of cancer . . . who eventually
dies from something else
Who is a cancer survivor?
Any person who . . .
has had a diagnosis of cancer
has completed treatment for cancer
has lived cancer-free 5 years beyond a cancer diagnosis
has a history of cancer . . . who eventually dies from something else
In parole più semplici: il paziente cui è stato eradicato un tumore
maligno che abbia terminato le
eventuali cure adiuvanti
"In 2006 the Institute of Medicine issued a report
recommending that every cancer patient receive an
individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to that
report, many groups have now developed various types of
"care plans" to help improve the quality of care of survivors as they move beyond their cancer treatment”.
What is a “Survivorship Care Plan?”
Institute of Medicine Report and National Research Council 2006 Report - From Cancer Patient to Cancer Survivor: Lost in Transition - www.iom.edu
"In 2006 the Institute of Medicine issued a report
recommending that every cancer patient receive an
individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to that
report, many groups have now developed various types of
"care plans" to help improve the quality of care of survivors as they move beyond their cancer treatment”.
What is a “Survivorship Care Plan?”
Institute of Medicine Report and National Research Council 2006 Report - From Cancer Patient to Cancer Survivor: Lost in Transition - www.iom.edu
“Strumento essenziale è la realizzazione di un programma di follow up, consistente in un piano basato su linee guida generali condivise e
validate scientificamente, ma personalizzato”.
AIOM-Consensus Conference
Dalla pratica del “follow up” alla cultura di “survivorship care”.
Roma, 10-11 settembre 2015
Bridging the ‘gap’ ...
Active Treatment Post Treatment Survival
Cancer Survivor Care Plan
−Epidemiology of cancer in Italy
−Definition of Survivorship Care Plan
−Survivorship Care Plan in action
−How to build an effective Survivorship Care Plan
−Conclusion
Agenda
Survivorship Care Plan In action
Survivor
Oncologist Primary Care
Physician (MMG) Psychologist
Nutrition Specialist Surgeon/RT
Others
From a Survivor’s point of view…
“One of the most common concerns survivors have is worrying the cancer will come back. The fear of recurrence is very real and
entirely normal. Anxious thoughts like “Has the cancer come back?”
and “What will happen if it does?” may be triggered by the appearance of a headache, cough, or joint stiffness, or it may precede events like your diagnosis anniversary or follow-up appointments and tests. For some survivors, these worries and
feelings of uncertainty lead to struggles with depression and anxiety.
However, it is important to remember that although you cannot directly control whether the cancer returns, you can control how much the fear of recurrence affects your life”.
Fear of recurrence
La paura della recidiva può comportare:
−distress moderato o severo con ansia e depressione
−attenzione ossessiva per possibili segni e sintomi di malattia
−eccessivo utilizzo di servizi sanitari a scopo di rassicurazione
−interferenza con la capacità di pianificazione per il futuro
Foster et al 2009, Koch L. 2013, Harrison 2011
From a Survivor’s point of view…
Cortesia di Anna Costantini
“I risultati di un’ampia indagine su 1275 survivors al cancro della mammella, colon retto e prostata evidenziano come il più frequente bisogno non corrisposto sia l’aiuto a gestire la preoccupazione sulla recidiva del cancro”.
−Perdita di tempo
−Perdita di tempo
−Perdita di tempo
−Ho un sacco di lavoro da finire
−“Che pesantezza”….Mi parlano di tutt’altro (cataratta, dieta, artrosi del ginocchio…)
From the oncologist’s point of view…
Atzori F. et tanti altri, 2017
−Cancer recurrences can be caught early
−Preventable conditions may be avoided
−Potentially lethal late affects may be averted
−Psychosocial distress can be addressed
−Quality of life may be improved
Potential Benefits of a Survivor Care Plan
From the oncologist’s point of view…
The way a doctor or other health or social care professional delivers news places an
indelible mark on the doctor/professional- patient relationship
The importance of communication
− Epidemiology of cancer in Italy
− Definition of Survivorship Care Plan
− Survivorship Care Plan in action
−How to build an effective Survivorship Care Plan
−Conclusion
Agenda
Setting up a Survivorship Care Plan
Prepare yourself
The importance of knowledge
Early Breast Cancer Surveillance Program
−Basato su linee guida e non sulle proprie convinzioni (si è sempre fatto così qua…perché cambiare?)
−Personalizzato per ogni paziente
(età, comorbidità, trattamenti adiuvanti)
−Evitare quanto più possibile la medicina difensiva e la
ridondanza degli esami (non dimentichiamoci che deve
sempre essere la clinica a guidarci)
An example of Cancer Survivor Care Plane
Dalla pratica del “follow up” alla cultura di
“survivorship care”
DOCUMENTO DI CONSENSO
Roma, 10-11 settembre 2015
Share the information
Giving the KNOWLEDGE
− Epidemiology of cancer in Italy
− Definition of Survivorship Care Plan
− Survivorship Care Plan in action
− How to build an effective Survivorship Care Plan
−Conclusion
Agenda
STRATEGY & SUMMARY
Conclusion
−I sopravviventi da cancro in Italia sono in progressivo aumento
−E’ indispensabile un programma di sorveglianza (Survivorship Care Plan)
−Un efficace “Survivorship Care Plan” si deve basare su:
• Linee guida nazionali
• Personalizzazione, autonomia e flessibilità (sono fondamentali per migliorare la QOL del paziente e dei medici che seguono a vario titolo il paziente)
−Il risparmio che deriverebbe da un efficace SCP in termini di tempo e denaro sarebbe rilevante per la comunità
