Few current cancer therapies are benign, and many carry substantial risk of adverse long-term or late effects. 1 Depending upon patient age at diagnosis (the median is 67 to 68 years) and the length of time projected for survival, comorbid conditions also may influence follow-up care. 2, 3 Survivors of cancer who have completed initial therapy generally require significant amounts of follow-up during the first two years after diagnosis. The frequency and intensity of monitoring diminishes with each subsequent year, with a dramatic decrease occurring two to five years posttreatment. Conversely, the risk of late effects from treatments and the impact of long-term effects increases with time. The progressive reduction in the number of follow-up visits may reflect a perceived decrease in the need for follow-up on the part of either the provider or the survivor. It may also reflect both a failure of the medical system to convey the risk for adverse treatment-related sequelae as well as system-driven barriers such as unequal access to care and disparities in the quality of care. Patient-driven factors such as fear of recurrence are also critical, and many survivors may not be aware of potential adverse long-term or late effects.

The scientific community has begun to call for cancer survivorship research and for solutions that will lead to increased length and quality of life for all cancer survivors. The 2005 Institute of Medicine (IOM) report on cancer survivors diagnosed as adults, From Cancer Patient to Cancer Survivor: Lost in Transition, articulates key areas for research and care delivery-in particular, the development of a formal care plan for survivors that integrates, within one document, key treatment-relevant variables, exposures, late-effect risks, and management and follow-up care needs. 4 An earlier IOM report, Ensuring Quality Cancer Care, recognized that attributes of high quality care could be linked to optimal outcomes such as enhanced length and quality of survival, and that continued follow-up for survivors should include basic standards of care that address the specific needs of long-term survivors. 5

The recommendations of this State of the Science symposium are an important step in delineating potential directions to follow to add to the growing knowledge base about cancer survivorship and to facilitate the development of evidence-based interventions and surveillance strategies. It is imperative that we achieve an evidence-based understanding of the frequency, setting, and experiences of follow-up care received by cancer survivors in order to develop standards for such care with a view towards prevention, early detection, or amelioration of long-term or late effects of cancer and its treatment. Findings from methodologically rigorous studies will improve our understanding of the burden of illness carried by cancer survivors, yield key information regarding follow-up care, and facilitate the development of standards or best practices for such care, especially when notable health disparities might exist.

CE 4.5 hours, Continuing Education

To receive 4.5 contact hours for the five special-content articles in this supplement-Foreword (page 3), Editorial (page 4), Executive Summary (page 6), The Shifting Paradigm of Cancer Care (page 16), and Discussion and Recommendations (page 91)-see page 96.

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