Metastatic Cancer and Survivorship: Unmet Needs of a Growing Population
Mon, 12/14/2020 - 17:57

By: Whitney Pitman, APRN

Hearing that your patient has been diagnosed with cancer is generally met with an instinctual sigh of worry and empathy. Learning that their cancer diagnosis is metastatic automatically cues the imagination to thoughts of death and sadness. However, with improving treatment options, increasing numbers of cancer therapy FDA approvals, and personalized medicine, metastatic patients are living longer and longer. This is great news for providers and cancer patients alike; however, it opens up a new world that may be unfamiliar for healthcare providers: metastatic cancer survivorship. 

Survival Rates Increasing for Metastatic Patients
The American Cancer Society’s 2020 cancer statistics report showcases that cancer-related deaths are on the downward slope and that five-year survival rates are increasing as well, even in the metastatic setting. For example, 39% of individuals diagnosed with distant oropharyngeal cancer are alive at five years and 27% of metastatic breast cancer patients will live beyond five years. With this growing patient population also comes growing patient needs and concerns. 

Unique Needs of Metastatic Patients
Current ASCO and NCCN survivorship standards focus on patients treated with curative intent. There is very little focus on metastatic survivorship despite this populations’ unique needs. Statistics tell us that 60-70% of metastatic cancer survivors deal with chronic pain, fatigue and weakness. Nearly 20% have symptoms consistent with depressive disorder and 14% meet criteria for general anxiety. Not to mention the never-ending roller coaster ride of “scanxiety,” fear of anticipated death, fearful of becoming a burden to family, loss of control, the stigma of their cancer diagnosis, and the financial burden of indefinite treatment.

Despite all of that, there is an unspoken judgment that the metastatic cancer patient should just feel thankful to “be alive.” Just being alive is not enough. Metastatic patients want to live well. Health care providers need to do a better job of recognizing the unique issues and concerns of this patient population. 

Coordination of Care
Better coordination of care is necessary. It is important to involve a patient’s primary care provider and other specialists in their cancer treatment. Oncologists need guidance from the PCP or other subspecialties about treating cholesterol, hypertension and other co-morbid issues that are not necessarily on their radar during routine cancer follow-ups. It is also important to offer each other guidance on other risk-reductive strategies. For example, a screening colonoscopy for a patient with metastatic prostate cancer may be warranted in many situations. It is no longer good enough to treat the cancer and wish patients a heartfelt “best wishes.” It is important to educate metastatic patients about their cancer diagnosis and other health care needs. Metastatic cancer patients should feel empowered to ask for more. 

The Impact of Living with Metastatic Cancer
More research is needed to study the psychological, spiritual, financial, and physical impact of living with a metastatic cancer diagnosis. One idea is to lean on research from other chronic, life shortening conditions. Cancer survivorship nomenclature and standards also need to be corrected to include the metastatic patient. Health care providers need education on screening for and meeting the needs of this growing population.  

Balancing hope and reality with metastatic cancer is not necessarily an exercise in futility.  In many cases, there is substantial evidence to suggest living beyond five years with advanced cancer is possible. It is the health care community’s responsibility to make living well with metastatic cancer possible. It is our job as health care professionals to educate ourselves on our patients’ needs and provide meaningful impact. Patients with metastatic cancer deserve the title of cancer survivor and the health care benefits that come with it.   

Whitney Pitman is a medical oncology nurse practitioner with UofL Health -- Brown Cancer Center's multidisciplinary breast cancer team. She also leads the Survivorship Clinic.