Health Services for Cancer Survivors
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Health Services for Cancer Survivors

Practice, Policy and Research
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Michael Feuerstein
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This book gives an integrative, evidence-based framework for improving the health of cancer survivors over the long term, across clinical settings and specific diagnoses. It reviews the current state of survivor care and offers a model of a proactive future.
Part 1. Current Concerns.- Specific challenges in optimizing the health care of survivors.- Providers' and cancer survivors' concerns about health care.- Epidemiology of recurrent and new cancers.- Symptoms over time: What is their role in surveillance?- Access to care among cancer survivors.- Symptoms among cancer survivors: Biobehavioral mechanisms and current health care response.- Part 2. Clinical Management.- General health.- Targeting provider-survivor communication.- Oncologic health.- Health behaviors: General strategies (diet, weight loss, exercise, stress).- Behavioral health.- Functional outcomes.- Self-management.- The cancer survivorship clinic.- The cancer survivorship plan.- Part 3. Current Needs and Future Directions.- What works, and what should be stepped up?- Future challenges and potential solutions.
Health has been conceptualized by world and national health organizations (WHO, CDC, Healthy People 2010) as more than the absence of disease. It involves a focus on physical, psychosocial, and functional aspects of life as well as the prevention of future illnesses. At this point in the development of quality health care for cancer survivors, there is sufficient knowledge and expert opinion to push efforts forward to improve the health of cancer survivors. Clearly there is more research in the most prevalent forms of cancers (e.g., breast cancer) than others that provide us with guidance on how to optimize their health, but there are data on other forms of cancers that can also better inform practice. There may also be general care practices that can cut across cancer types. There has been an emergence of epidemiological and clinical research in cancer survivors that can form the basis for a revolution in the quality and nature of health care that survivors receive. This book not only provides the reader with diverse perspectives and data but also integrates this information so it can serve as the foundation necessary to improve and maintain the health of cancer survivors.
Reporting of symptoms to health care providers is a complex, multi-determined problem influenced not only by the pathophysiology but also, as we have learned over the years through pain research, by societal, cultural, and biobehavioral factors. This book will consider this important aspect of follow-up for millions of cancer survivors because of the strong reliance on symptom reporting for clinical decision making. In order for us to generate meaningful and effective treatment, we need to better understand the symptom experience in cancer survivors. This book provides much information that will assist us to better understand and manage this complicated end point. The presenting problems need to be articulated and "conceptualized" as clearly as possible by both parties so appropriate actions can be taken. Since health care costs are a major concern for patients, payers, and providers, this area will also be addressed in all the relevant sections.
In taking an interdisciplinary perspective, this book illustrates the importance of a team approach to the improvement of health care and associated health, well-being, and functioning in cancer survivors. The 17 chapters cover critical topics of which physicians and providers of all types must be aware in order to provide the most comprehensive and responsive care for cancer survivors. All of the clinical care chapters include case studies to illustrate the real-world application of these approaches in cancer survivors. Information about sources of referral both within and outside the traditional health care communities will be provided in tabular form. There is no other text that provides both an overview of the problems and their challenges, case illustrations of direct application, and the reality of reimbursement for such care. The editors hope that there may be no need for the clinician or the survivor to adapt to a "new normal" if the presenting problems are understood and handled from an interdisciplinary perspective as outlined here.