Nearly 19 million people in the U.S. are living after a cancer diagnosis, yet many complete their treatment without a clear roadmap for what comes next. Despite growing evidence that lasting physical, emotional, and cognitive effects can surface long after care ends, the transition into survivorship remains complex.
City of Hope has made long-standing investments in survivorship research and care to ensure patients lead longer, healthier lives after treatment. The progress is historic:
To help voice the critical needs of this growing community, City of Hope launched the “City of Hope Line” this June in honor of National Cancer Survivors Month. The initiative invites survivors, caregivers, loved ones, clinicians, and community members to share short messages answering one simple but powerful question: “What would you say to someone who just heard the words, ‘You have cancer’?”
BlackDoctor spoke with Dr. Saro Armenian of City of Hope about this vital evolution in cancer care. From managing long-term physical and psychosocial side effects to addressing systemic health disparities and the promise of precision survivorship, Dr. Armenian outlines why a proactive, personalized approach is essential. He also provides actionable advice on how survivors can navigate their care, advocate for their own health, and leverage new technologies to ensure they receive the comprehensive, lifelong support they deserve.
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Over the last few decades, there has been an incredible amount of investment in better diagnostic and prevention strategies—such as big public health efforts on smoking prevention and lifestyle modification—as well as early screening and better treatments. The combination of those investments has resulted in the largest gains we’ve ever made in cancer survival. It’s now expected that seven out of 10 cancer survivors will survive five years or more. That is a really big milestone; for the majority of people diagnosed with cancer, a cure is now an expected outcome, which is a paradigm shift.
This improvement in outcomes has resulted in a rapidly growing population of cancer survivors. In the U.S. alone, there are close to 19 million. We are also recognizing that this is a unique population; many of these people are surviving 10, 15, or 20 years. They have unique journeys and lives after their treatment, with physical, psychosocial, financial, and emotional needs that we are just starting to recognize as different from the general population. This has opened up our awareness of the field of cancer survivorship, and the need to invest in survivorship care has emerged as an important issue.
Given how fragmented the healthcare landscape is, it is incredibly important for survivors to be their own best advocates. First, they must recognize that they are a unique population that requires monitoring for late effects or subsequent complications of therapy that differ from the general population. Most people want to put their treatment behind them and move on, but the reality is that there are unique needs that must be addressed by both the oncology team and the primary care team.
Second, survivors should have access to their own treatment information. They should know their cancer diagnosis, the stage, and how they were treated—whether it was surgery, radiation, or specific chemotherapy medicines. They need to be informed about potential long-term side effects so that if they develop, they can be proactive in managing them. This includes early detection of cardiovascular disease, which occurs at a higher rate in survivors, and monitoring for secondary cancers. Ultimately, it’s about relationships and understanding that they need to rely on their community and support network. We have learned that the fragmentation of our healthcare system is a major challenge to people receiving equitable, survivorship-focused care.
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They should ask for what we call a treatment summary that provides a plain-language breakdown of their treatments and potential side effects. Every major oncology organization, such as the American Society of Clinical Oncology (ASCO), recommends this as part of the standard of care. Patients should ask for this from their primary oncology team once treatment is done. If they aren’t able to get one, I would advocate for them to seek out centers with established survivorship programs, like we have here at City of Hope, which can help them navigate to get that information.
Ultimately, a cancer survivor who has received intensive therapies—like chemotherapy, bone marrow transplantation, or intensive radiation—should continue care with their primary care doctor but also have some form of survivorship-focused care overseen by an expert in the area. It doesn’t have to be a physician; it could be a nurse practitioner or an advanced practice provider, but there needs to be someone who is going to help guide them through the rest of their life.
Health disparities are deeply rooted in our healthcare system. Racial and ethnic minority populations continue to experience worse cancer-specific and overall survival compared to their peers. Even though we have a 70 percent overall survival rate, there are disparities where racial and ethnic minorities do not have the same survival rates as their non-Hispanic white counterparts. This may be due to differences in access to care, treatment delivery, or comorbidities at the time of diagnosis. There are structural inequities where minority patients are more likely to be diagnosed at an advanced stage, have delays in initiating treatment, and have less access to high-volume centers and specialists.
Even after cancer treatment is done, there are clear disparities in survivors not receiving the same level or comprehensiveness of survivorship-focused care. They tend to have a higher burden of health complications, especially a higher risk of cardiovascular disease. Many do not receive appropriate screening and early detection. It’s not necessarily biological; a lot of this is driven by structural and systemic factors like environmental exposures and social determinants of health. It is definitely a focus of ours at City of Hope to think about innovative strategies for delivering survivorship-focused care across all populations.
There are real psychosocial challenges. Many patients struggle to come to terms with the long-term physical side effects, and that impacts their relationships. Having peer support, groups, or a healthcare professional trained to help them navigate issues like chronic pain or depression is incredibly important.
Financial toxicity is also under-discussed. The out-of-pocket costs associated with cancer treatment can place a disproportionate burden on racial and ethnic minorities and substantially impact an individual’s long-term well-being. Finally, we have to remember that cancer and its treatment are fundamental disruptors of life. Many people have a hard time reintegrating back into work, school, and the things that provide stability.
One thing I want to add: people have the sense that survivorship care can only be provided in the cancer center, but many of these services can be done remotely. One of the great benefits of advances in technology is that we are able to do counseling, education, and real-time triage remotely. That is a game-changer and will continue to be as we move forward.
Our commitment to our patients doesn’t begin and end with the diagnosis or treatment. In fact, our commitment is just as strong, if not stronger, once they finish their treatment because we believe it is a journey. We want to be a partner for them for the decades they have ahead.
We are exploring how to deliver precision-based survivorship care the same way you would deliver precision-based cancer treatment. You don’t treat every cancer patient with the same chemotherapy; it’s the same for survivorship—not every survivor needs the same follow-up. We are investing in personalized survivorship care where we meet the patient where they are, including those who are not physically able to come for in-person follow-up. We also need to think about biosensors and Bluetooth-enabled technology to give us real data and biological information about how patients are doing in the community. I fundamentally believe it is our moral obligation to care for our survivors to the best of our abilities in the most precise way possible.
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