Health outcomes in cancer survivors

Abstract

Cancer survivors are reported to have poorer health outcomes than the general population, both as a consequence of the cancer treatment and lifestyle factors common to cancer risk and to other medical conditions. The traditional specialist oncology model of follow-up care for cancer survivors is increasingly recognised to be inadequate, both in capacity and in provision of holistic care. This thesis describes studies characterising the symptoms, unmet needs, and quality of life concerns of cancer survivors, including in the previously understudied population of women with ovarian cancer. In addition, a study of potential genetic predictors of the most prevalent symptom domains reported by survivors was undertaken. Finally, a specialist assessment and care planning model of survivorship care was evaluated. High levels of unmet need were identified in cross-sectional studies of a general cohort of cancer survivors from NSW, and in an international cohort of women with ovarian cancer. The NSW survivors reported a discordant endorsement of specialist-led follow-up over proposed alternative models of care despite high levels of unmet survivorship need with traditional follow-up care. In ovarian cancer, associations were seen between physical activity and obesity with a range of symptoms, supportive care needs and quality of life; and longitudinal data demonstrated that the majority of patients recovered quickly after primary cancer treatment, but a subset with more severe symptoms at the end of treatment had protracted ill health which impacted on quality of life. The specialist cancer survivorship clinic was found to be feasible, and was associated with gains in lifestyle knowledge and behaviours, and self-efficacy. Polymorphisms in cytokine and neuroregulatory genes were identified which contributed in a cumulative fashion to the risk and recovery trajectory of common symptoms after breast cancer including fatigue, mood disturbance, pain and neurocognitive dysfunction. Future work should focus on better understanding of the biological basis for adverse health outcomes to underpin prevention, early detection and treatment implemented via risk-based triage models of survivorship care.