The number of cancer survivors is increasing. It is projected that there will be more than 13.7 million cancer survivors in the United States, with 59% of survivors being older than 65 years.1 This can be largely attributed to advances in cancer detection and treatment. The 5-year survival rate for all cancers increased significantly in the past decade. Cancer researchers are striving to achieve their goal of turning the disease from a death sentence to a chronic illness, which would be a remarkable scientific achievement. However, although people may soon routinely live decades with their cancer in remission or even cured, they will not be immortal. Most will eventually experience some other debilitating conditions and require long-term support and services. However, as healthcare professionals, we are not ready to address this situation. We do not have confidence in providing long-term cancer care, care planning, and complex symptom management in long-term care facilities or communities.

Health insurances in many parts of the world pay for numerous expensive anticancer therapies but do not cover a long-term home care aide. Cancer care has become a long-term care issue, but there is a paucity of published literature on the long-term care issue. Patients with cancer treatment-related toxicity or cancer-related symptoms may require complex services including skilled nursing, rehabilitation, and symptom management in long-term care. With population aging, the number of patients with cancer will increase in long-term care facilities because cancer occurs more commonly in older adults. Frailty and decreased physiological reserve in older adults may increase their risk of further functional decline and make them more susceptible to adverse outcomes such as institutionalization and/or mortality. Patients with cancer 70 years and older have an average of 3 comorbidities that can affect the evolution and treatment of cancer and demand more sophisticated and complex cancer care. Healthcare systems for cancer have historically been organized for acute illness episodes and treatment delivery rather than for the management of chronic illness problems. Symptoms can emerge months to years after the completion of therapy; evidence is emerging of an increased long-term risk of comorbidities. The incidence of osteoporosis, diabetes, and heart failure is higher in patients with breast, prostate, and colorectal cancers than in age-matched controls.2 In addition, new emerging cancer therapies have a range of late-effect profiles with possible complications3 that may develop later in life. Providing services to manage these complications has been identified as a priority for long-term cancer care in the United Kingdom.4

Faithfull et al5 indicated that the self-reported confidence of nurses and allied health professionals in managing all areas of care for adult cancer survivors is variable with deficits in crucial areas of practice. Those responding had perceived gaps in knowledge and educational needs. In cancer aftercare, a requisite shift to proactive care, supported self-management, and collaborative management of patients' long-term consequences of cancer and its treatment is yet to be addressed. Deficits in confidence have been found across professional groups in long-term medication management, care planning, and complex symptom management for cancer survivors. An innovative approach to adult cancer follow-up requires making effective use of the workforce, ensuring that the right skills and education are available to provide safe and effective long-term care. Advances in cancer research can prolong patients' lives, as well as improve their long-term quality of life. Are we ready for this challenge?

Sincerely,

- Chia-Chin Lin, PhD, RN, FAAN

College of Nursing, School of Nursing

Taipei Medical University, Taipei, Taiwan

and Li Ka Shing Faculty of Medicine

School of Nursing, The University of Hong Kong

Pok Fu Lam, Hong Kong

References