Defining Cancer Survivorship Care

The Institute of Medicine (IOM; now the National Academies of Sciences, Engineering, and Medicine) recognized the unique needs of cancer survivors in their 2006 landmark report, From Cancer Patient to Cancer Survivor: Lost in Transition . IOM recommendations for survivorship care included four components: (1) prevention and detection of new cancers and recurrence; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for the physical and psychological impacts of cancer and its treatment; and (4) coordination between specialists and primary care providers. At the time, this definition centered primarily on post-treatment survivorship care, where the person with cancer had completed treatment and had no evidence of disease. Over the last decade, however, the National Cancer Institute (NCI) and other organizations have emphasized the broad definition of a cancer survivor from the time of a cancer diagnosis forward. This includes those who are living with their cancer as well as those who are free from their cancer. The term is meant to capture a population of those with a history of cancer rather than provide a label that may or may not resonate with all people impacted by cancer.

The increasing recognition of the broader definition of a cancer survivor also means that the health care needs of survivors may vary greatly. As such, it was necessary to broaden the definition of cancer survivorship care to recognize these complex needs. NCI’s Office of Cancer Survivorship recently released a definition for cancer survivorship care . This definition was adapted from the National Standards for Cancer Survivorship Care , which details essential health system policy and process components of survivorship care programs and proposed metrics for the evaluation of the quality of survivorship care. The National Standards for Survivorship Care build upon previous work, including the Quality of Cancer Survivorship Care Framework , which defined domains of quality care. ?

Cancer survivorship care is comprehensive care for all people who have a history of cancer. It begins at the time of diagnosis, has the goal of assessing and mitigating the impact of cancer and its treatment, and includes the following components of care:

Surveillance and amelioration of physical, emotional, and psychological effects, including evaluation of risk, prevention, and management of late effects

Surveillance for recurrence and new cancers

Assessment and promotion of health behaviors (e.g., smoking cessation, physical activity)

Coordination of care between care team members, health systems, survivors, and caregivers

Addressing comorbidities and preventing and managing chronic conditions exacerbated by cancer and its treatment

Engagement in care planning, including discussing goals of care and advanced care planning

Provision of supportive health services (e.g., nutrition, occupational and physical therapy, rehabilitation, sexual health, fertility services, dental and podiatry services)

Genetic risk assessment or referral to genetic testing as appropriate

Management of social risks, health-related social needs, education and employment

Addressing financial hardship and insurance coverage

It is important to recognize that there is great diversity among the over 18 million cancer survivors in the United States today . There is truly not a one-size-fits-all approach to the delivery of survivorship care, and all of the components above may not be necessary for every cancer survivor. As a result, care should be tailored to the needs of the survivor, with a goal of risk-based survivorship care.

There may be multiple providers with overlapping, simultaneous, shared, or sequential involvement in the delivery of survivorship care, including the oncology team, primary care providers, psychologists, rehabilitation specialists, and other health care professionals. This complex care requires coordination between all care team members and health systems involved, as well as survivors and their caregivers. Finally, care teams should discuss goals of care with survivors and their caregivers to ensure that survivorship care meets their needs from the time of diagnosis forward.?

To view more definitions and more information, please visit the NCI Office of Cancer Survivorship website .

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Mollica MA, McWhirter G, Tonorezos E, et al. Developing national cancer survivorship standards to inform quality of care in the United States using a consensus approach . J Cancer Surviv. 2024 Aug;18(4):1190–1199.