A cancer survivor is an individual who has been diagnosed with cancer, regardless of when that diagnosis was received and is still living [1]. Considering the diagnosis, response to treatment, morbidity and mortality of disease there are three distinct phases associated with cancer survival :

1. The time from diagnosis to treatment
2. Transition from treatment to immediate survival
3. Long-term survival [2].

Over the past 25 years, the number of cancer survivors has increased from three million to nearly twelve million due to progress in the treatment of cancer. However, advanced treatment has often failed to provide survivors with care that address the side effects of both cancer and its treatment, which have a significant effect on their quality of life. American society of clinical oncology (ASCO) has identified biggest hurdle in care of cancer survivors, which is unassisted transition from an orderly system of hospital based care to a "non-system" in which there are no guidelines to assist them through the next stage of their life or help them overcome the medical and psychosocial problems [3]. This observation is true worldwide.

In 1986, National Coalition for Cancer Survivorship (NCCS) was formed with a goal to change the perception of cancer victim to survivor. This society stressed the need to include family, friends, and caregivers. National Cancer Institute established the Office of Cancer Survivorship in 1996 with the main objective to support research in cancer care. This office aimed to understand the physical, psychological, economic issues and attempted to increase the quality of life of survivors. It also intended to provide education to healthcare professionals and survivors about health related issues [4]. The Institutes of Medicine (IOM) published two subsequent reports on care of cancer survivors in 2006. Both reports recommended that survivors should get a detailed care plan to assess and treat the potential long-term effects due to cancer and its treatment. These reports also identified primary care providers as partners in the care of cancer survivors [5]. Table 1 shows the brief summary of 10 recommendations passed in the IOM meeting. National Cancer Survivorship Resource Center was formed in 2010, with collaboration between the American Cancer Society and the George Washington University Cancer Institute, and is funded through a cooperative agreement with the Centers for Disease Control and Prevention. This center identified 10 cancer sites based on survivor prevalence and the severity of long-term or late effects These 10 cancer sites were colorectal, prostate, lung, breast, cervix, ovarian, endometrial, uterine, melanoma and head and neck cancers [6]. This office has also recommended to strengthen and follow 2006 IOM guidelines as outlined in Table 1.

Where are the evidence based guidelines for healthcare workers
National comprehensive cancer network (NCCN) is a pioneer society in establishing and publishing evidence based guidelines for treatment site and stage specific cancer. The NCCN publishes and updates survivorship guidelines based on expert panel recommendations it incorporates steps that are related to late effects of cancer which are mostly neurocognitive such as anxiety, depression, cognitive function, fatigue, sleep disorders, chronic pain, and sexual function [7]. The complaint specific guidelines are also available such as pain, emesis, infections and regular surveillance. American society of clinical oncology (ASCO) also publishes and regularly updates guidelines that focus on providing guidance for the management of long-term and late effects such as chemotherapy related neuropathy, deep vein thrombosis, mental symptoms such as stress depression, fatigue. ASCO has previously published and now updated follow-up guidelines for patients with prostate, breast colorectal cancer.

The Institutes of Medicine (IOM) report identified four essential components of survivorship care: prevention, surveillance, intervention, and coordination. Cancer care is continuously evolving process. Oncologist and primary care physicians both hold the equally important positions in the life of cancer survivor. The goal of cancer survivorship is to empower survivors and their families. Cancer survivors should be given detailed follow up plan after primary treatment for better improvement in their quality of life.

Keywords: Cancer care, Cancer survivorship, Guidelines

We acknowledge the contribution of Sr Prof. Dr R.K Karwasra (HOD Surgical oncology PGIMS Rohtak) & Prof Sanjeev Parshad for bringing this important topic into our minds and conceptualizing it.

1. Centers for Disease Control and Prevention. (2008). Cancer survivor-ship. Retrieved May 23, 2009. [Availabe at: http://www.cdc.gov/cancer/survivorship/basic_info]    
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