HOLLYWOOD, Florida (EGMN) — Many people experience fear, anxiety, and depression during the transition from cancer patient to survivor, according to a panel of oncologists, survivors, patient advocates, and others at the annual conference of the U.S. National Comprehensive Cancer Network.

Patients should be screened at the very least for anxiety and depression after the acute treatment period, said Mary S. McCabe, R.N., who runs a program for adult cancer survivors at Memorial Sloan-Kettering Cancer Center in New York City. In her experience, many patients can handle their initial treatment psychologically, “but they then run out of gas, and face both anxiety and depression. . . .They tell us that this is often the scariest time after the diagnosis. Up until then, there has been a plan.”

Oncologists need to start addressing the gambit of patients’ concerns before they transition back to their primary care provider, said Elizabeth Edwards, patient advocate, attorney, and wife of former U.S. Senator and vice presidential candidate John Edwards. She noted that oncologists are the ideal providers to discuss end-of-life concerns with survivors.

“I have developed trust with this person, I have placed my life in their hands, and I want to hear information from them, even if they refer me,” said Ms. Edwards, who has breast cancer.

It helps when oncologists address end-of-life early in the course of treatment, said Dr. Douglas W. Blayney, medical director at the University of Michigan Comprehensive Cancer Center, Ann Arbor. He typically tells patients: “We will only talk about the end now, once, and you can bring it up any time you want.” Having that conversation proactively and “letting the patient know you’re open, that you’re not going to talk doom and gloom all the time,” helps people feel comfortable talking about their biggest worry. “Working that into your conversation at the second or third visit saves time down the road, and it’s the polite thing to do.”

Quality of life issues are also important, said Dr. Blayney, who urged oncologists to be open to a discussion of sexual health issues. “Many of us at large institutions have a team who can explore these things . . . but we as doctors need to introduce that to patients,” said Dr. Blayney, who is incoming president of the American Society of Clinical Oncology.

“Patients assume we only want to know what happens to them physically, but [sexuality] is a huge area of recovery for patients,” agreed Ms. McCabe.

Oncologists need to be proactive about asking survivors about all aspects of their lives, said Dr. Kenneth Miller, medical director, Lance Armstrong Foundation Adult Cancer Survivorship Clinic at the Dana Farber Cancer Institute in Boston. “Often, we ask cancer survivors how they are doing and they say ‘fine.’ But there is a family member there nodding their heads no.”

An automated system that screens survivors for various issues would be ideal, said Catherine M. Alfano, Ph.D., program director, National Cancer Institute Office of Cancer Survivorship. The Institute of Medicine outlined such a systematic process in an October 2007 report called “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.” The number of issues that some patients want to discuss can be “overwhelming,” she said. Addressing these issues in a systematic way is key.

Patients have a tough time transitioning to primary care. “People want to cling to their cancer treatment providers. But clearly the doctors and nurses have to move on to take care of other people,” said Sam Donaldson, former television anchor and a survivor of melanoma from a diagnosis in 1995.

Oncologists have a significant role to play in easing that transition. New guidelines from NCCN address Cancer Survivorship Care, and are aimed at guiding this process.

The transition time is also a period of opportunity, when doctors can teach patients how to optimize their time as survivors, and emphasize the importance of healthy nutrition, exercise, bone health, and smoking cessation.

Acute care and long-term survivorship “are both teachable moments,” said Dr. Miller.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

佛罗里达州好莱坞（EGMN）——一个由肿瘤专家、存活患者、患者支持者及其他人士组成的小组在美国国家综合癌症网络（NCCN）的年度会议上指出，从罹患癌症到治疗后存活这一过渡时期，许多肿瘤存活患者经历了恐惧、焦虑和抑郁情绪。

肿瘤急性期治疗后，至少应对患者是否存在焦虑和抑郁情绪进行筛查，纽约市Sloan-Kettering纪念癌症中心肿瘤存活成年患者项目负责人，注册护士Mary S. McCabe说道。根据她的经验，许多患者能初步处理自身心理方面的问题。“但随后，他们会耗尽精力和热情，面临焦虑和抑郁的困扰……他们告诉我们，这往往是诊断后最可怕的时期。从那时起，就应制订相关计划。”

肿瘤专家应在患者转诊到初级保健机构之前着手解决他们所关注的问题，患者支持者、前美国参议员和副总统候选人John Edwards的妻子Elizabeth Edwards说道。她指出，肿瘤专家是和存活患者探讨临终问题的理想人选。

 “我对他们产生信任并以生命托付，我希望从他们口中听到消息，即使是我将转诊。”乳腺癌患者Edwards女士说道。

肿瘤专家在治疗的早期提到临终问题将很有帮助，密歇根大学安娜堡分校综合性肿瘤中心医务主任Douglas W. Blayney博士说。他通常会告诉病人，“现在，我们将讨论临终问题，但只谈一次，当然你可以在任何时候再提出来讨论。”主动进行这样的谈话，“让病人知道你是开放的，但也不是总将生与死挂在嘴边。”这样，患者在谈论他们最担心的问题时不会感到难过。“在第二次或第三次查房的某个适当时候进行上述谈话，既节约时间，同时也体现出礼貌。”

生活质量问题也很重要，Blayney博士说。他鼓励肿瘤专家采取开放的态度来讨论性健康问题。“我们当中许多人供职于大型机构，有能够探索这些问题的团队……但作为医生，我们必须向患者介绍有关性的问题。”美国临床肿瘤学会（ASCO）新任主席Blayney 博士说道。

 “病人认为我们只想知道他们身体状况，但‘性’是患者恢复期一个很大的问题。” McCabe女士对此表示赞同。

肿瘤专家应主动询问存活患者生活中各方面的情况，波士顿市达纳法伯癌症研究所(Dana Farber Cancer Institute) Lance Armstrong基金会成人癌症存活临床部医务主任Kenneth Miller博士说道。“我们问肿瘤存活患者最近过得怎么样，他们自己说‘很好’，但家属通常会有在旁边摇头表示否认。”

利用自动化系统监测存活患者的各种问题是最理想的，美国国家癌症研究所（NCI）癌症存活办公室项目主任Catherine M. Alfano博士说道。该研究所在2007年10月以“癌症患者的全方位护理：满足心理健康需求”为题做了一份报告，概述了这样一种系统性过程。有些患者想要探讨的问题会很多，采用系统性方式来解决这些问题是关键，她说。

存活患者转诊到初级保健机构会经历一段困难的时期。“肿瘤患者想继续依赖自己的经治医生和护士。但显然，医护人员不得不照顾其他患者。” 一名1995年被诊断为恶性黑素瘤的存活患者，前电视主播Sam Donaldson说道。

在过渡时期，肿瘤专家在缓解患者情绪方面起着关键作用。NCCN新的指南制订了关于肿瘤存活患者保健的内容，旨在指导这一过程。

过渡期同样也是一个机遇期，医生可以教育肿瘤存活患者如何合理利用自己的时间，并向患者强调健康饮食、身体锻炼、骨健康以及戒烟的重要性。

在肿瘤急性病治疗和长期的存活期间，“都可对患者进行相关知识的宣教。”Miller博士说。 

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