Guest Commentary by Dr. Julia H. Rowland
Cancer Survivorship Research: Translating Science to Care
As more than 500 researchers, patient advocates, cancer care specialists, public health officials, and others gathered outside Washington, DC, on June 14–16 for the Sixth Biennial Cancer Survivorship Research Conference, the American Cancer Society announced that an estimated 13.7 million people in the United States are living after a cancer diagnosis, and the estimated number of cancer survivors is expected to increase to almost 18 million by 2022.
These numbers, based on data from NCI's Surveillance, Epidemiology, and End Results Program, underscore the need for the biennial conference. The event, which began in 2002, brings together those involved in cancer survivorship research and the delivery of survivors' post-treatment care to discuss findings and to work together to advance the field.
The meeting is jointly sponsored by NCI's Office of Cancer Survivorship, the American Cancer Society's Behavioral Research Center, the Lance Armstrong Foundation, and the Centers for Disease Control and Prevention. As one speaker at the conference said, "With over 13 million survivors in the U.S., we need to get this right."
I looked forward to this year's conference with great enthusiasm, and my high expectations were surpassed. The conference theme, "Cancer Survivorship Research: Translating Science to Care," reflected the growing consensus about the importance of translating scientific discoveries into clinical and behavioral interventions and replicating the work across diverse populations.
We were fortunate to have Dr. Russell Glasgow, NCI's deputy director of Implementation Science, provide the "bookend" talks for this event. He launched the dialogue by walking the audience through the translational science process from basic scientific discovery to public health impact, and he challenged us to consider how we were going to move survivorship research along this pathway. Building on this theme, each plenary, special session, and symposium placed new findings along the "lab bench to park bench continuum" to stimulate thinking about how best to translate research into real-life practice.
The first plenary session focused on obesity, a national public health issue of particular concern to cancer survivors and their caregivers, given the increased likelihood of weight gain in some populations following a cancer diagnosis, as well as the increased health risks associated with obesity. Speakers presented new animal studies that are informing behavior change interventions for survivors who need them most, population studies demonstrating that obesity might not have the same effects on all survivors, and weight-control programs that have successfully reduced obesity in at-risk populations. (See the NCI Cancer Bulletin special issue on obesity and cancer research.)
A second plenary session explored issues related to health equity. In her introduction to this session, NCI's Dr. Shobha Srinivasan reminded the audience that we have a long way to go in addressing what she pointedly described as "avoidable inequalities."
Toward that end, Dr. Melinda Stolley of the University of Illinois at Chicago described a new weight-loss program, "Moving Forward Together." The program is tailored to the needs of African American breast cancer survivors, the majority of whom are obese or overweight at diagnosis and at risk for further weight gain when treated for cancer. In turn, UCLA's Dr. Jackie Casillas provided details of her collaboration with community partners to develop materials for a photonovella designed to promote awareness of survivors' needs and reduce the stigma attached to cancer in the Hispanic community. Dr. Linda Burhansstipanov reminded us that American Indian/Alaska Native survivors may be particularly vulnerable to adverse outcomes, due to the already high burden of comorbid diseases like diabetes in these populations.
A critical take-home message from this plenary was: We as researchers must work diligently to build programs that are sustainable and have a life after our study is done. And this challenge is especially important for work conducted with minority and medically underserved groups.
A final plenary emphasized the importance of communication and coordination during post-treatment care of cancer survivors. In this session, NCI researcher Dr. Neeraj Arora, who is also a cancer survivor, poignantly illustrated how a cancer survivor can feel "homeless in a world of medical homes." Survivors are often shuttled between primary care providers, oncologists, and other specialists whose medical expertise may become necessary as a result of the late effects of treatment, he explained, without any communication or coordination of care between these doctors.
Dr. Arora noted that the existence of multiple comorbidities compounds this problem in the older population, which actually composes the majority of cancer survivors today.
The conference's symposia and special sessions focused on the numerous targeted concerns of cancer survivors and those who care for them, including
- stress, fatigue, cognitive, and cardiac effects of cancer treatment;
- economic issues;
- resilience (what enables some patients to better cope with a cancer diagnosis and the resulting treatment and after effects);
- survivorship care planning;
- adherence to treatment and after care;
- communication within the family;
- sexuality and relationships; and
- the many other possible psychosocial effects of cancer survivorship.
The conference's translational framework helped participants in the biennial's special survivor/advocate program better understand the research under way, recent study results, and how the study findings can be put into practice to optimize physical and psychosocial functioning and prolong the lives of cancer survivors. At the same time, researchers at the conference gained invaluable insight into the needs and concerns of cancer survivors.
Dr. Glasgow closed the conference, summarizing the greatest tasks that stand before the cancer survivorship research community as we continue to design and conduct research, with an eye toward translating that research into high-quality, cost-effective care across populations. He pointed to the need for a balance between fidelity to evidence-based programs and adaptation to a local setting or population. He encouraged those of us in the cancer survivorship field to be good journalists and to ask: "Who, what, when, where, why, and how?"
Those of us in the field will remember these central questions as we address the needs of cancer survivors and bring better care to this ever-growing population.
Dr. Julia H. Rowland
Director, NCI Office of Cancer Survivorship