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癌症生存
Cancer Survivorship


Charles L. Shapiro ... 肿瘤 • 2018.12.20

癌症筛查和早期检测的进展、治疗方法的改进以及支持性治疗均促进了癌症死亡率的降低。图1显示了从1975年至2040年,癌症人群人口统计学特征的变化。2040年估计将有2,600万名癌症生存者,其中大多数为60多岁、70多岁或80多岁1。几乎每一名医务人员都会遇到癌症生存者。本综述主要针对初级保健医师、妇产科医师、中级医务人员和患者为癌症生存者的专科医师。对于外科医师、放射治疗医师和可能不熟悉癌症生存这一广泛主题的肿瘤内科医师,本综述也可作为入门文章。目前,癌症生存者的照护往往是事后想法,常常零散残缺,没有很好地融入癌症治疗的主流。此外,生存者的最佳照护模式仍未确定。

 

图1. 美国癌症生存者的人口统计学特征变化

图中显示的是从1975年至2040年,按年龄组别划分的癌症生存者人数,1975年时有360万名癌症生存者,预计到2040年将有2,610万名生存者。2011年的垂直虚线显示的是第一批婴儿潮(1946—1964年出生的人口)达到65岁的年份。数据来自Bluethmann等的论文1

 

根据美国国立癌症研究所癌症生存办公室(Office of Cancer Survivorship)2和其他组织(例如美国疾病控制与预防中心和美国全国癌症生存联盟[National Coalition for Cancer Survivorship])观点,癌症生存从诊断时开始,并持续整个生命期。这一整体定义鼓励临床医师将生存者照护视为癌症治疗连续统一体的一个组成部分。生存者的定义中包括家庭成员、朋友和照护人员。包括这些人的主要原因是,在大多数情况下,患者并非独自经历癌症。照护人员是无名英雄,为癌症生存者提供身体和精神上的支持。认识到对照护人员健康的不良影响和情绪损害是这一广义生存定义的一部分。

美国国家科学院、工程院和医学院在一份具有里程碑意义的出版物中确定了生存者照护的要点3,这些要点在美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)癌症生存教育核心课程中得到了扩展4。下面对这些报告中阐明的主题进行回顾。





作者信息

Charles L. Shapiro, M.D.
From the Icahn School of Medicine at Mount Sinai Uptown, New York. Address reprint requests to Dr. Shapiro at the Icahn School of Medicine, 1 Gustave L. Levy Pl., Box 1079, New York, NY 10029, or at charles.shapiro@mssm.edu.

 

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