Personalized Symptom Management for Cancer Survivorship

Worldwide, the number of cancer survivors is growing due to better treatments and population aging. Individuals with cancer experience significant symptom burden during early and post-treatment survivorship that can be disabling. Many survivors continue to grapple with long term physical and emotional symptoms and late effects that negatively impact functioning in daily life and quality of life. The P5 personalized medicine framework comprised of preventive, prediction, personalization, participatory, and psycho-cognitive components can be used to guide personalized symptom management in survivorship. While targeting of therapeutic agents to biological mechanisms is an essential aspect of personalized medicine, attention to the “whole” person experience of cancer and treatment is what patients/survivors want and desire when they are ill. Clinicians assessments of how patients are functioning in routine care, their symptoms and quality of life are central to a personalized symptom management approach. Routine use of patient reported outcome (PRO) data in the clinical encounter and using mobile health technologies can improve prevention and prediction of symptoms and empower survivors in disease self-management. PROs when used in “everyday” clinical practice enhances patient/provider communication, reduces symptom burden and health care utilization, improves quality of life and may have a survival benefit. PROs can also facilitate engagement of survivors in symptom monitoring and promote adjustment of behaviors to optimize functioning in daily life. Thus, equal attention must be focused on the participatory component of personalized symptom management that encourages involvement of patients as partners in care and supporting their self-efficacy in learning to live with cancer as a chronic disease. Personalized symptom management only becomes possible when both survivors and clinicians work in partnership to optimize symptom management and health. Individuals with cancer experience significant symptom burden during early and post-treatment survivorship that can be disabling. Many survivors continue to grapple with long term physical and emotional symptoms and late effects that negatively impact functioning in daily life and quality of life. Fear of cancer recurrence or progression, a specific type of anxiety, also can occur both before and after treatment. Long term physical and emotional symptoms can disrupt functioning in daily life, occupational or career goals, marital and family relationships, and lead to financial distress. Patient-generated health data (PGHD) are health-related data created, recorded, or gathered by or from patients to help address a health concern. A practical example of patient reported outcome (PROs) for personalized symptom management can be observed at the William Osler Health System Cancer Survivorship Clinic (WOHS-CSC) in Ontario led by Dr. Martin Chasen.