Beyond Survival: Improving Quality of Life After Cancer Treatment

The American Cancer Society estimates that there are 15.5 million individuals who have survived cancer in the United States, and that number is projected to increase to approximately 20 million by 2020 as treatments continue to improve. However, many lifesaving treatments cause side effects that can negatively affect quality of life.

The Cancer Survivorship Clinic at the Duke Cancer Institute (DCI) is an innovative clinic, offering a unique, multidisciplinary environment, with providers in a wide range of specialties, to coordinate care and combine treatment plans to minimize and treat any adverse effects of patients’ primary cancer treatments and enhance their quality of life.

Urologic cancers account for approximately 50% of male and female cancer survivors, many of whom successfully overcome the disease but develop troublesome treatment-related side effects. In addition, even more individuals may develop side effects related to their urologic organs following treatment for a different type of malignancy; for example, patients who have survived colorectal cancer frequently develop incontinence after their primary treatment.

“We’ve been getting much better at treating cancers with different modalities and improving the length of survival for patients, but now we need to turn our attention to taking better care of patients after their primary treatment is over,” says Andrew Peterson, MD, a Duke urologist who has been instrumental in the clinic’s growth, both in size and national reputation.

Peterson notes that the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) produced a 2005 report titled Lost in Transition that was critical of the ability of the United States’ medical system to care for patients who had survived cancer. “All these years later, we’re still dealing with that issue,” he says. “Medical and surgical oncologists in all specialties have become so good at treating patients that we expect approximately 75% of those patients today will still be alive in 10 years. We need to focus not only on survival but also use our expertise to better treat the side effects that impact quality of life.”

The most common urologic side effects treated include sexual dysfunction, voiding dysfunction, bowel dysfunction, and fistulas. Treatments range from behavioral therapy and physical therapy to medications, reconstructive surgery, and, most recently, infertility treatment. For patients who received their cancer treatment at DCI, the co-located Survivorship Clinic provides coordinated care with their oncology team as well as a familiar setting with familiar faces, which helps foster a sense of well-being.

A number of industry and association grants have helped the clinic grow rapidly and enabled the launch of the Duke Reconstructive Urology and Cancer Survivorship Fellowship program, training physicians in survivorship in a multidisciplinary environment. Peterson notes that other organizations are becoming increasingly interested in visiting the clinic and working to emulate it, as concern grows for treating the unique and often poorly understood needs of cancer survivors.