Better support for long-term symptoms is needed


image: Dr Martina Schmidt of the German Cancer Research Center (DKFZ) in Heidelberg, Germany
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Credit: ESMO

Lugano, Switzerland, September 18, 2021 – Previous standards of cancer care and follow-up support may no longer meet current needs, as improvements in screening practices, early diagnosis and treatment of cancer have put long-term survival beyond five years after diagnosis within the reach of more than half of patients in Europe. (1) While beating cancer must be followed by a return to normal life, the side effects of anti-cancer drugs and the impacts of the disease itself that sometimes persist after the end of treatment can hamper this process. Confirming the need for new approaches to cancer survival, a study (2) [to be] presented to the ESMO Congress 2021 shows that a significant proportion of survivors continue to suffer from distressing symptoms for several years and reveals widespread dissatisfaction with the help received.

Professor Dorothy Keefe, CEO of Australia’s National Cancer Agency, Cancer Australia, chair of the supportive and palliative care component of the congress, not involved in the study, highlighted its importance in a context where survival research has lagged behind cancer treatment research. “This is probably due to the increase in survival rates itself lagging behind the introduction of new therapies, but also a lack of prioritization on the need to develop a cure,” Keefe said, highlighting the scale of the problem today: “We now have millions of cancer survivors in Australia, hundreds of millions around the world – and an ever-growing number who could potentially have long-term side effects.”

One of the most common symptoms experienced by patients and survivors is cancer-related fatigue (CRF), a lingering feeling of exhaustion that is not alleviated by sleep or rest and that significantly interferes with the person’s usual functioning. The FiX study initially assessed the characteristics, severity (3) and management (4) of CRF in 2,508 patients with 15 different types of cancer two years after discovery of their disease. In a follow-up survey of 36 potential long-term problems, completed by participants about four years after diagnosis, almost 40% of survivors continued to report fatigue that they considered to be moderate or severe burden. In addition to fatigue, more than 40% of patients said they were at least moderately burdened with loss of physical ability and more than a third suffered from sleep disturbances, sexual problems, joint pain and anxiety.

While there are recommendations on managing side effects like CRF, including ESMO’s clinical practice guidelines for its diagnosis and treatment (5), study author Dr Martina Schmidt of the German Cancer Research Center (DKFZ) in Heidelberg, Germany, pointed out that their implementation is still lacking and reported that more than one in three people affected in the study rated the support that has given them been offered for fatigue as being weak. “Despite a growing awareness of the effectiveness of mitigation measures like exercise in reducing fatigue, patients are still too often left alone to seek help for symptoms that cannot be directly treated with. medication in the same way as something like pain, for which satisfaction with the support received was high in our study.

Commenting on the results, Keefe observed: “This research shows that an incredibly high number of patients still suffer from significant health problems years after being declared free from the disease. Their dissatisfaction with the care available is a wake-up call that we should pay more attention to these people, trying to understand the mechanisms at play in order to identify interventions that could help them recover better.

According to Schmidt, cancer follow-up care should therefore no longer focus only on the immediate side effects of treatment and the detection of metastases or recurrence of the cancer, but also include more systematic screening for additional symptoms that can weigh down patients. “The first step should be to make sure that the patients themselves are better informed about these potential problems early on, so that they know that conditions such as CRF are not only expected, but often manageable and that ‘they shouldn’t wait for symptoms to go away on their own. ,” she said.

Recognizing that possible models of long-term support remain largely untested, Keefe further advocated that all patients receive a survival care plan when they reach the end of their treatment. “Going forward, we need to develop these models of care in ways that minimize the burden on health systems, implement them and research their impact so that we can look back in five years and assess whether they have made a difference to the cancer. survivors, ”she concluded.


Notes to Editors
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The references
1 Source: European Cancer Information System
2 Abstract 1669O_PR “Late Effects, Long-Term Problems and Unmet Needs of Cancer Survivors” will be presented by Martina Schmidt during the communication session offered on Tuesday, September 21, from 1:30 p.m. to 2:50 p.m. (CEST) on Channel 4. Annals of Oncology, Volume 32, 2021 Supplement 5
3 ME Schmidt, S. Hermann, V. Arndt and K. Steindorf. Prevalence and severity of long-term physical, emotional and cognitive fatigue in 15 different cancerous entities.
4 ME Schmidt, S. Bergbold, S. Hermann and K. Steindorf. Knowledge, Perceptions and Management of Cancer-Related Fatigue: The Patient Perspective.
5 A. Fabi, R. Bhargava, S. Fatigoni, M. Guglielmo, M. Horneber, F. Roila, J. Weis, K. Jordan and CI Ripamonti. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment.

About the European Society for Medical Oncology (ESMO)
ESMO is the leading professional organization in medical oncology. With over 25,000 members representing oncology professionals from over 160 countries around the world, ESMO is the benchmark society for oncology education and information. Driven by a shared determination to ensure the best possible outcomes for patients, ESMO is committed to supporting those who care about cancer by meeting the diverse needs of the #ONEoncology community, offering #educationforLIFE and advocating for #accessiblecancerCARE

1669O_PR – Late effects, long-term problems and unmet needs of cancer survivors

 ME Schmidt1, S. Hermann2, K. Steindorf1 

1Division of Physical Activity, Prevention and Cancer, DKFZ – German Cancer Research Center, Heidelberg, Germany,2Baden-Württemberg Cancer Epidemiological Register, DKFZ – German Cancer Research Center, Heidelberg, Germany

Background:Great efforts and impressive progress are being made in the treatment of tumors. However, research and care regarding the long-term problems and late effects of cancer in survivors of the disease is still insufficient.

Methods :The FiX study enrolled 2,508 patients in 15 different cancerous entities approximately 2 years after diagnosis via a cancer epidemiological registry in Germany, with the main aim of assessing the pattern, severity and impact of fatigue. A follow-up survey was carried out between 12/2020 and 04/2021. Using a list of 36 potential long-term or late-effect issues, participants were asked how much of a burden these are / were on them (no / little / moderate / severe / extreme ) and, if burdened, how they rate the support received for that issue (good / moderate / bad).

Results:1,874 participants (76%) responded to the follow-up survey at a median (Q1, Q3) of 4.2 (3.8, 4.8) years after cancer diagnosis. This population had a mean age (SD) of 65.8 (11.2) years and 49% were female. The most frequently reported problems with at least moderate burden were: loss of physical capacity (40.7%), fatigue (38.5%), sleep problems (36.6%), sexual problems ( 35.4%), arthralgia (33.4%), anxiety (33.2%) and neuropathy (28.9%). Cardiac disorders and osteoporosis weigh respectively on 15.6% and 11.9% of survivors. Extreme burden was most often assessed for sexual problems (10.1%), primarily in men with prostate cancer. This was also the problem with the highest proportion of dissatisfaction with the support received (44.7% of affected survivors rated the support as weak). Management of fatigue was rated poor by 37.7% and only good by 29.5% of affected survivors. Support was also reported to be low for neuropathy (35.9%), cognitive problems (35.3%), weight gain (34.7%) or hot flashes / night sweats (33.7 %). In contrast, support for pain was considered good by a majority (51.3%). Determinants of different charges and satisfaction with support have been identified.

Conclusion:A significant number of cancer survivors suffer from long-term effects. Our study identified several groups with open needs for improved supportive care.

Identification of clinical NCT03318224
Legal person responsible for the study:N / A
Funding:Received no funding
Disclosure:All of the authors have declared no conflict of interest.


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