Cancer patient vs. survivor
Erasing the line in the sand

Chronic Health Care Model for Cancer Survivorship 
A chronic health care model for cancer survivorship. 

It’s still more common than not for “cancer survivors” to be placed solely in the post-treatment category – a misconception that Jennifer Klemp, Ph.D., of Cancer Prevention, would like to see changed. Better to think of cancer survivors along a continuum, she says, that starts from the time of diagnosis. 

In other words, “this umbrella model doesn’t distinguish between patient and survivor,” she elaborates. “It’s about incorporating strategies like supportive care and oncology rehabilitation that impact quality of life – both physically and psychosocially – right off the bat. If you wait until a person has been boxed in under “cancer-free survival” or “treatment failure,” it may be too late.” 

Given that by 2020, an estimated 18 million people will be grappling with the late and long-term effects of being treated for cancer – including neuropathy, weight gain and lymphedema – the time to be proactive is now. “The old model where you regularly follow up with your oncologist, even post-remission, no longer works,” Klemp says. “There are too many new patients, on top of those with active disease; you wait hours for a visit that lasts 10 minutes. It’s critical mass colliding with quality of care.”

But it will, in fact, “take a village” to change the game with cancer survivorship – words that Klemp has taken to heart in collaborating with providers outside of oncology to help them become more comfortable working in a cancer setting. At KU Cancer Center, robust relationships have been built with the likes of cardiology and fertility specialists, resulting in streamlined referral processes and improved access to other aspects of health care that patients frequently need as much as cancer expertise. Klemp points out one such thriving relationship: with Samuel Kim, M.D., director of the reproductive endocrinology division within KU Medical Center’s department of obstetrics and gynecology. While the toxicity of cancer therapy often wipes out a woman’s ability to bear children, Kim is one of a mere handful of clinicians in the U.S. who can provide such patients a fertility-restoring option – by cryopreserving their ovarian tissue pre-treatment and, later, transplanting it back into the body. 

In facilitating these relationships with medical experts and other health care professionals, Klemp makes good use of Cancer Survivorship Training (CST) Inc., a KU startup company of which she is chief executive officer. CST disseminates continuing education on topics related to cancer survivorship care accessed through the web and any mobile device, also called eLearning solutions, and its custom branded educational curriculum, easily integrated into existing web portals, now exists across all of the Masonic Cancer Alliance’s partner hospitals.

The myriad aspects of cancer survivorship have also prompted some active research – for instance, a recent study led by Qamar Khan, M.D., on adherence to long-term therapy. He and several colleagues, including Klemp, found that high-dose vitamin D supplements mitigate the severe musculoskeletal symptoms and fatigue that often plague women with ER-positive breast cancer taking antihormonal drugs like letrozole, and therefore help them comply with their therapeutic regimen. Additionally, Klemp and Christie Befort, Ph.D., are carrying out their sixth study on weight management in cancer survivorship: Befort holds RO1 funding from the National Institutes of Health to explore ways to integrate diet and exercise programs early on and thereby help breast cancer survivors from rural communities maintain a grip on successful weight loss.

Klemp has expanded this model to target cardiopulmonary fitness on top of weight loss and exercise; breast cancer survivors are otherwise at considerable risk of death from cardiovascular disease, due to various factors including the cardiotoxicity of certain therapies and a more sedentary lifestyle. With the aid of resistance training powerblocks – “peelable” weights with a range from three to 21 pounds – participants are randomized to either standard or interval exercise sessions. The key difference is that the latter group, rather than simply exercising for 30 minutes until “it’s a little difficult to talk,” as Klemp puts it, utilize a Garmin heart rate monitor and, for short 30-second or one-minute intervals, push themselves to Zone 2 on said monitor, whereby talking becomes near impossible. So far, all indications are that such bursts of increased intensity during exercise sessions result in statistically significant improvements where cardiopulmonary fitness is concerned. A similar intervention for prostate cancer survivors, many of whom are also overweight or obese, has since been proposed. 

Klemp is also part of a community engagement effort between KU Cancer Center and Children’s Mercy Hospital in Kansas City, Mo., focusing on adult survivors of childhood cancers. Having surveyed the informational needs of roughly 130 young adults in this category, she and her colleagues started a transitions clinic – run by Becky Lowry, M.D., and Stephen Smith, M.D., from KU; along with Joy Fulbright, M.D., from CMH – this summer with the aim of helping these survivors make the necessary adjustments both during and after transitioning to adult care. 

“Overall, it’s time to conceptualize cancer survivorship in terms of chronic health care, the way we do for diabetes or cardiovascular disease,” Klemp says. “It’s a complicated model that will involve pairing multiple community resources, from advocacy groups to government agencies, with a hugely complex health care system. But I think it’s necessary, and that the emphasis should be on productive two-way interactions between well-informed patients and prepared, proactive providers.

Funding sources for this research

  • NIH RO1 CA155014: “Group Phone-Based Weight Control Among Rural Breast Cancer Survivors”
  • NIH K12 HD052027: Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Faculty Development Program
  • 2012–2013 Pilot Award, The University of Kansas Cancer Center: “Feasibility of a Dose-Response Exercise Intervention in Breast Cancer Survivors”
  • Masonic Cancer Alliance Partners Advisory Board
  • Back in the Swing, USA 
  • Ribbons of Pink Foundation

Relevant publications

  • Klemp JR, Knight CJ, Ranallo LB, Fabian CJ, “The Demands of Cancer Survivorship: The Who, What, When, Where, Why, and How.” Commun Oncol (Sept 2013). 
  • Klemp JR, Frazier LM, Glennon C, Trunececk J, Irwin M, “Improving cancer survivorship care: oncology nurses’ educational needs and preferred methods of learning.” J of Cancer Education (Jun 2011).