Over the past decade, the number of cancer survivors has increased substantially, and with an ageing European population and increasingly effective cancer therapies, the number of survivors is only projected to rise. Yet, cancer survivorship can be a lifelong struggle and almost all EU countries lack adequate policies to ensure rehabilitation and smooth reintegration of cancer survivors into social and professional life. The end of cancer treatment does not signal the end of cancer care. In this survivorship phase, patients’ wellbeing must be considered, not only long-term physical effects of treatment, but also psychological, social, and economic needs.
Cancer survivorships consist of three main pillars: medical or clinical aspects, socioeconomic aspects, and legal and political aspects. Each of these pillars has a series of challenges that need to be addressed. The first pillar includes medical and clinical aspects. Cancer-related complications and comorbidities add a significant burden on patients across Europe and are in many cases fatal.
There is a need to alleviate this burden through better risk assessment and treatment as cancer-related complications and comorbidities have an impact on quality of life, cancer treatment and its efficacy as well as survivorship.
An important matter that needs further consideration is that In Europe cancer survivorship research is usually not integrated into activities related to cancer although it should be an inherent aspect. Furthermore, there is a lack of data intelligence to prioritize cancer survivorship research, thus, robust data should be used to identify the existing research gaps in survivorship. When prioritizing the cancer survivorship agenda, survivors’ needs must be reflected and be the focus. However, it is important to state that this should be carried out with an integrated approach as research needs to be done in cooperation with all partners involved (including international collaboration). Research must be both interdisciplinary and patient-centred and it needs to include assessment of the wellbeing of cancer survivors.
Research programmes in the field of cancer survivorship ought to be not only patient-centred but also age-adapted to meet the need of children, adolescents, and adult survivors.
A European Cancer Survivorship Research Plan should be developed to share best practices, promote research and innovation, and support the 70:35 vision (an average of 70% survival is to be achieved in Europe by 2035).
Research activities in palliative care should also be promoted. Regarding the second pillar, socioeconomic aspects present challenges related to inequalities, Quality of Life, and support. One of the main challenges is the lack of knowledge on social determinant of cancer inequalities which have an impact on cancer survivorship (specially in Central and Eastern Europe).
So, analyses should be conducted in order to examine the impact, address patients’ needs and inequalities more broadly. We also lack data concerning the economic burden of cancer for survivors so the implementation of economic evaluations should be considered, and new research tools would examine the QoL of cancer survivors. The absence of data on the impact and cost effectiveness of interventions for cancer survivors is one of the challenges. To this end, cancer survivorship research should be integrated into all National Cancer Control Plans (NCCP) in which caregivers and family members should also be contemplated.
Overall, there is lack of support for cancer survivorship research at European level and social issues are usually not combined within cancer survivorship research. Research on social issues should be implemented to attain greater stability considering patients’ health needs and work and social needs.
Lastly, the third pillar includes the legal and political aspects. It is important to emphasize the promotion of studies on legal aspects of discrimination for cancer survivors as well as the analysis of legal provisions stimulating essential elements such as reintegration, quality, and social inclusion. In this regard, the Right to Be Forgotten needs to be highlighted: once the cure of cancer is declared, patients should be back to their lives, as other people of similar age and socio-demographic characteristics with no cancer diagnosis. Moreover, the above-mentioned European Cancer Survivorship Research Plan should be incorporated to the European Cancer Mission with the 70:35 vision. Research programmes should define the existing stigmas linked to cancer to advocate for a change so that survivorship is at the centre of the stage. Cancer survivors have the right to return to normal life and therefore guidelines on the way survivorship is organized ought to be developed, good practices need to be promoted and patients must be and feel empowered.