Objective Approach to Survivorship Helps Address All Elements

Smita Bhatia

Smita Bhatia

At the inaugural 2016 Cancer Survivorship Symposium in San Francisco, Smita Bhatia delivered a lecture titled “Long-Term and Late Effects: The Science of Survivorship,” in which she spoke about personalizing cancer survivorship care, encouraging oncologists to be interested in survivorship, and exploring what’s next in the field.

Oncology Nursing News spoke with Bhatia, the director of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham School of Medicine, to discuss the lecture and key issues in cancer survivorship.

What were some of the main points you wanted to make in your talk?

My goal was to do three things. First, I wanted to present a landscape of the burden of morbidity that cancer survivors face. I wanted to walk the audience through the causes of these long-term complications and then try and break it down into what could be increasing the risk. Is it genetics? Is it age or sex of the patient? Is it the lifestyle exposures?

The bulk of my talk was to address the need to understand the molecular mechanisms — at the DNA level — of how therapeutic exposures increase the risk of these complications, and use that to develop prediction models. With these, we might be able to say that if someone walks in with a brand new cancer, and we're planning on exposing them to a particular chemotherapy or radiation therapy, that we could predict whether the patient is at very high risk of heart failure, for example. Then, we can personalize the treatment we want to give.

In the final part of my lecture, I discussed risk reduction strategies. In cases when patients have already been exposed to chemotherapy or radiation, the question remains: How can we reduce their risk of developing these complications?

Are there certain survivorship issues that get more or less attention than others?

It divides into the adult world and the pediatric world. In the adult world, most research has been in understanding quality of life and psychosocial issues in cancer survivors — especially in breast cancer survivors. In the pediatric world, it's been along the lines of the physical complications that patients might face as survivors.

There has been less attention to bringing back survivors for a head-to-toe comprehensive assessment of all their complications. At the end of the day, we have to understand that we give our cancer patients huge amounts of treatment. We give them a lot of chemotherapy, radiation and other biological agents. We would be naïve to think these treatments don't have any effect on the organ systems — it's important that we follow our survivors long term to understand that impact.

What work still needs to be done?

The studies are now more focused on the pathogenesis — trying to determine, at the DNA level, what is increasing risk? We want to be able to predict which patients are at highest risk.

What excites you most about the field of cancer survivorship care?

We can see a place in time where we will continue to have the same cure rates we do now, but we'll have much less toxicity. These patients will have more productive and healthier lives than we're affording them now.

What barriers are standing in the way?

We need time, funding and resources to conduct these studies. Any time you want to do research, it requires resources. We need funding. The dollars are tight right now, and it's challenging to get the right amount of funding.

Do you think it’s particularly difficult to get funding for survivorship care studies?

I don't think that’s the case. There is still a need to increase awareness about survivorship issues, however. There is more of a need for this in the adult oncology world — they are a few years behind the pediatric oncology world in terms of understanding and being aware of the needs of patients after the completion of treatment. I believe there needs to be a comprehensive plan to take care of survivors, long term.

Why is a meeting like this important?

A meeting like this excites me tremendously because it brings together two sets of people who are primarily responsible for taking care of patients who've survived cancer: primary care providers and oncologists. Having these groups work in partnership together is critical. For survivors, my message is that they need to be advocates of their own care. They need to be aware of their own issues and seek care for themselves.

Why did you choose the title of your lecture, “The Science of Survivorship?”

I believe we need to examine the entity called survivorship in an objective and scientific fashion. When we do that, we can then break down and address individual components.

I think this would get more oncologists involved and interested in survivorship, too. Survivorship sometimes gets a bad rap — oncologists may feel that it's all just psychosocial stuff. Of course that is important, and we do want to make sure the quality of life of our survivors remains intact. There are other questions, though: What goes behind the quality of life? What are the issues that impact quality of life? We’re trying to understand all of these components.