The treatment cancer survivors are missing

Most oncologists were trained to focus on simply keeping people alive, but with cancer survivors making up 5.4 percent of the U.S. population, new issues in life post cancer are rising, AJMC reported April 15.

Cancer survivors are experiencing sleep disorders, fatigue and cognitive issues sometimes years after being clear of cancer.

Insomnia and other sleep disorders are often self-reported, leading to little data about the correlation between sleep and cancer treatment and survival. 

"We really have no bloody clue how many of our patients are survivors [who] really have diagnosable sleep disorders," Eric Zhou, PhD, an assistant professor of pediatrics in the division of sleep at Boston-based Dana-Farber Cancer Institute and Harvard Medical School, said in the report.

A survey by the National Cancer Institute found the 25 best programs were only giving insomnia treatment to half of survivors, despite sleep disorders being one of the largest issues facing patients during and after treatment. Dr. Zhou recommended centers include sleep disorder screenings in the existing workflow, provide more resources to patients and train providers to address sleep issues.

Fatigue is another long-standing issue for patients.

"We can have up to 50 percent of patients still reporting fatigue in long-term survivorship, [five] or more years from diagnosis," Kristin Dickinson, PhD, RN, assistant professor of nursing at the Omaha, Neb.-based Fred & Pamela Buffett Cancer Center, said in the report. "We're seeing on average 30 percent of patients reporting that fatigue is a distressing symptom in their life. In terms of quality of life, fatigue is often under reported under diagnosed and undertreated."

A survey found only 20 percent of patients believe anything can be done for fatigue, so they often do not report it. National Comprehensive Cancer Network guidelines recommend screening for fatigue even before treatment and continuing screening at every recurring visit.

Cognitive issues will affect 50 percent to 70 percent of patients during treatment. Even before cancer treatment, surgery and anesthesia can cause cognitive issues in up to a third of patients with cancer, according to the report.

"If you look at long-term cross sectional data, if cancer survivors in the general population have about a 14 percent reporting of memory problems — which compares with about 8 percent in the general population without a cancer history — and if you look at those individuals who had chemotherapy, that rate is even higher," Halle Moore, MD, of Cleveland Clinic's Taussig Cancer Institute, said in the report.

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