Defining Survivorship Trajectories Across Patients With Solid Tumors: An Evidence-Based Approach

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Cancer survivorship care involves multidisciplinary teams but lacks standardized timing for transitioning care.
• Current practices often rely on arbitrary 5-year cutoffs, which may not reflect individual cancer risks.

Purpose of the Study:

• To determine distinct high- and low-risk periods for various cancer types.
• To inform optimal timing for oncologists versus primary care physicians in overseeing cancer survivorship care.

Main Methods:

• A longitudinal, observational study analyzed population-level data from the Surveillance, Epidemiology, and End Results (SEER) database.
• Excess mortality hazard was calculated to define high-risk periods, and mortality gaps quantified excess risk in later survivorship.

Main Results:

• Evaluated 2,317,185 patients across 66 tumor types, revealing high-risk surveillance periods ranging from under 1 year to 19 years.
• Identified 6 distinct risk clusters with varying survival and high-risk period durations.
• Annualized mortality gaps ranged from 0.26% to 9.33% excess mortality.

Conclusions:

• A standardized 5-year surveillance period is inadequate for some cancers and excessive for others.
• High-risk cancers necessitate longer follow-up with oncologists due to prolonged high-risk periods and persistent mortality.
• Stratification by cancer stage and histology can refine risk assessment and care guidance.