To the Editor:

Recently, the article by the American Society of Clinical Oncology Cancer Survivorship Expert Panel¹ and the Editorial by Earle et al² raised the issues on the development of guideline recommendations for ongoing care of adult and pediatric cancer survivors. Earle et al first pointed out the heterogeneity of cancer survivors: different age, different cancers, different treatments, different exposure to antiblastic agents, and different risk of recurrence; second, he focused on the difficulty of surveillance strategy: too many patients to be followed-up for a long period of time. Patients that are survivors generally demonstrate infrequent clinical visits.

We believe that, to overcome some of these problems, first we have to strictly define the population to be studied. Usually, anyone who has been diagnosed with cancer, from the time of diagnosis to time of death, is considered a cancer survivor. In our opinion, this definition—pooling together cancer survivors, who might live with active disease and on treatments, with long-term survivors free from disease and exempt from therapy for a long period of time—could be confusing in order to evaluate late side effects and sequelae as well as to establish guidelines for their management. Therefore, these evaluations must be strictly referred to a patient population without evidence of cancer and free from specific treatment for a defined period of at least 5 years. Also, it could be better to start focusing on different studies of a single cancer type, where it is possible to find a relatively large number of patients that are defined as long-term cancer survivors and that have been treated with truly homogenous treatments, then to compare the effects of different regimens and different diseases and finally drawing comprehensive guidelines. Finally, it could help to focus the evaluation on patients younger than 60 years to avoid the bias due to comorbidity.

Finally, we believe that the institution of specific clinics devoted to cancer survivors offering integrated research and rehabilitation programs could overcome difficulties related to the effort of contacting survivors outside their usual infrequent visits. In fact, many peripheral or less specialized centers could refer their patients to these dedicated clinics. Moreover, the aim of these specific clinics is to answer the rehabilitation needs of cancer survivors through specific multidisciplinary programs combining clinical, genetic, and psychologic evaluations to be shared with cancer patient associations. We firmly believe that only through collaboration between oncologists and patient associations can we enhance the implementation of such prospective studies and set efficacious rehabilitation programs for cancer survivors.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.