The stage of the disease, which indicates the size of the tumour and the involvement or spread to other parts of the body.
Biological and molecular markers that give an idea of the speed with which the cancer may grow and spread.
The patient’s age and state of health before developing the cancer.
Response to treatment.
Understanding the statistics
The statistics about the prognosis for each type and stage of cancer are given as the “5-year survival rate”.
What is the 5-year survival rate?
This indicates the number of people with the same type and stage of cancer who will survive for a certain period of time (in this case 5 years) after the initial diagnosis. These rates do not indicate how long an individual will live, but they can help explain how effective the treatment is. For example, a 5-year survival rate of 90% means that 90 out of 100 people who have that cancer will still be alive 5 years after being diagnosed. However, many people live for much longer than 5 years after diagnosis.
What is the relative survival rate?
This is a more accurate way of estimating the effect cancer has on survival. These rates make a comparison between people with cancer and people in the general population. For instance, if the 5-year relative survival rate for a specific type and stage of cancer is 90%, then it means that people with this cancer have, on average, approximately a 90% chance of living at least 5 years after diagnosis in comparison with others who do not have this cancer.
It is important to stress that the 5-year relative survival rates are estimates based on calculations; each patient’s prognosis may vary depending on a series of specific factors.
Limitations of the statistics
To obtain 5-year survival rates, doctors must assess patients who have received treatment for at least 5 years. As treatments improve with time, individuals who are diagnosed with cancer today may have a better prognosis than the one suggested by current statistics.
Follow-up in patients with cancer
Follow-up after primary treatment
Cancer does not disappear completely in some people. They may receive treatment on a regular basis with chemotherapy, radiotherapy, or other treatments to maintain the cancer under control and receive a specific follow-up adjusted to the progression of the disease.
If the treatment has eliminated the tumour or overcome the cancer, patients may still have concerns about the possibility of acquiring another cancer. Such events are known as “new chronic conditions”, in other words, situations that until recently were only contemplated from the perspective of an acute disease (diagnosis and treatment) but which are now considered in the long-term. This applies to other conditions besides cancer. This concept of “new chronic conditions” can also apply to seronegative HIV patients or patients with Down syndrome who reach old age.
In the case of cancer, the main aim of follow-up after the primary treatment is:
To detect local or distant recurrences.
To detect and treat treatment complications. An adverse effect is considered to be an unintentional lesion or damage that is caused by any of the treatments and not by the actual disease.
Prevention and early treatment of psychological changes secondary to the cancer or its treatment. Psychosocial changes require prevention, detection and early treatment with systems that provide psychosocial support and promote occupational reintegration.
Long-term survivors after cancer remission
Long-term survivors are individuals who survive for a prolonged period after cancer remission. Fortunately, the cancer survivor population is constantly growing. Cancer survivors are recognised as being in a phase of cancer care. Quality care for survivors includes monitoring for recurrence and second tumours, intervention in the control of symptoms and psychosocial needs, and care coordination.
The survival stage after primary treatment can imply a period of education and an opportunity for the patient to recover their health and healthy lifestyle habits with respect to non-cancer health problems. This is a very important point, and in Spain they are already developing post-cancer treatment intervention projects to address issues such as nutrition, physical exercise and weight control.
Care programmes for survivors include:
Early detection of recurrence.
Early intervention in complications associated with cancer and its treatment.
Health promotion. Reduction of the risk of developing comorbidities or second tumours.
Assessment and intervention in the socioeconomic consequences of cancer and its treatment.
Standardisation of access to work.
Coordination with primary healthcare. Sharing of information, referral circuits and protocols.