Survivorship and MDT working in gynaecological oncology

She finished her chemoradiotherapy for stage IIB cervical cancer nine months ago, her scans are clear, and the cancer is gone — but she is back in your clinic in tears, not with bleeding, but with painful intercourse that has shut down her relationship, a leg that aches and swells, hot flushes that wreck her sleep, and a conviction that every twinge is the cancer returning. Cure was the operation; survivorship is the appointment in front of you. If your survivorship visit stops at "vault smear and CA-125 normal, see you in six months," you have missed the entire disease.[5][11]

Survivorship defined — and why it is its own topic

A cancer survivor is defined from the moment of diagnosis through the balance of life, and survivorship care is organised across three phases: the acute phase (diagnosis to completion of primary treatment), the extended phase (surveillance and recovery), and permanent long-term survival. For gynaecological oncology this is no longer a fringe concern — rising endometrial cancer incidence, high cervical and ovarian survival, and the durable toxicity of pelvic radiotherapy mean most of your patients will spend far more of their lives as survivors than as patients on treatment.[1][2]

The defining insight of modern survivorship care is that surveillance and survivorship are not the same thing. Surveillance is the hunt for recurrence. Survivorship is the whole-of-life management of the consequences of disease and treatment. A clinic that does only the first delivers a woman with a clear scan and a ruined life. The survivorship care plan is the instrument that forces both into one document.[1][4]