task identified by Fitzhugh Mullan, a physician and cancer survivor, who in 1985 said, “The challenge in overcoming cancer is not only to find therapies that will prevent or arrest the disease quickly, but also to map the middle ground of survivorship and minimize its medical and social hazards” (Mullan, 1985). This report focuses on survivors of adult cancer during the phase of care that follows primary treatment. The committee recognized the importance of addressing unmet needs of the large and growing number of cancer survivors during this phase of care. Previous IOM reports addressed the needs of childhood cancer survivors (IOM, 2003) and issues concerning care at the end of life (IOM, 1997, 2001b).

The committee reviewed the consequences of cancer and its treatment and concluded that they are substantial. Although the population of cancer survivors is heterogeneous, with some having few late effects of their cancer and its treatment, others suffer permanent and disabling symptoms that impair normal functioning. Psychological distress, sexual dysfunction, infertility, impaired organ function, cosmetic changes, and limitations in mobility, communication, and cognition are among the problems faced by some cancer survivors. The good news is that there is much that can be done to avoid, ameliorate, or arrest these late effects of cancer. To ensure the best possible outcomes for cancer survivors, the committee aims in this report to:

  1. Raise awareness of the medical, functional, and psychosocial consequences of cancer and its treatment.

  2. Define quality health care for cancer survivors and identify strategies to achieve it.

  3. Improve the quality of life of cancer survivors through policies to ensure their access to psychosocial services, fair employment practices, and health insurance.

The committee’s findings and recommendations that follow are directed to cancer patients and their advocates, health care providers and their leadership, health insurers and plans, employers, research sponsors, and the public and their elected representatives.

RAISING AWARENESS OF CANCER SURVIVORSHIP

There are many ways to define cancer survivorship, but for the purpose of this report, it is a distinct phase of the cancer trajectory which has been relatively neglected in advocacy, education, clinical practice, and research. Quality cancer survivorship care involves the provision of four essential components of care within a delivery system that facilitates access to comprehensive and coordinated care (Box ES-1). Raising awareness of the medi-



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