ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe

I. Vaz-Luis (1, 2), M. Masiero (3, 4), G. Cavaletti (5), A. Cervantes (6, 7), R. T. Chlebowski (8), G. Curigliano (3,9), E. Felip (10), A. R. Ferreira (11, 12), P. A. Ganz (13), J. Hegarty (14), J. Jeon (15), C. Johansen (16), F. Joly (17), K. Jordan (18, 19), B. Koczwara (20), P. Lagergren (21, 22), M. Lambertini (23, 24), D. Lenihan (25), H. Linardou (26), C. Loprinzi (27), A. H. Partridge (28), S. Rauh (29), K. Steindorf (30), W. van der Graaf (31, 32), L. van de Poll-Franse (33, 34, 35), G. Pentheroudakis (36), S. Peters (36) & G. Pravettoni (3,4)

(1) Breast Cancer Unit, Medical Oncology Department, Gustave Roussy – Cancer Campus, Villejuif
(2) UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy – Cancer Campus, Villejuif, France
(3) Department of Oncology and Hemato-Oncology, University of Milano, Milan
(4) Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, IRCCS, Milan
(5) Experimental Neurology Unit, School of Medicine and Surgery, University of Milano Bicocca, Monza; Italy
(6) Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia
(7) CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
(8) The Lundquist Institute, Torrance, USA
(9) Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
(10) Vall d’Hebron University Hospital, Barcelona, Spain
(11) Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon
(12) Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
(13) UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
(14) School of Nursing and Midwifery, University College Cork, Cork, Ireland
(15) Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center
Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
(16) Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(17) Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
(18) Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam
(19) Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
(20) Flinders Medical Centre and Flinders University, Adelaide, Australia
(21) Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(22) Department of Surgery and Cancer, Imperial College London, London, UK
(23) Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
(24) Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
(25) International Cardio-Oncology Society, Tampa, USA
(26) Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
(27) Mayo Clinic, Rochester
(28) Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
(29) Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
(30) Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor
Diseases (NCT), Heidelberg, Germany
(31) Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam
(32) Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
(33) Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam;
(34) Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
(35) CoRPS–Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University,
Tilburg, The Netherlands
(36) European Society for Medical Oncology (ESMO), Lugano, Switzerland

Background: The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship.

Design and methods: Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research.

Results: We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and
patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patientcentered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care.

Conclusions: The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.