Effects of a Cancer Survivorship Clinic—preliminary results

  • Anish Jammu
  • Martin ChasenEmail author
  • Rardi van Heest
  • Sean Hollingshead
  • Deepanjali Kaushik
  • Harprit Gill
  • Ravi Bhargava
Original Article



Initial investigation of the impact of a Cancer Survivorship Clinic following its introduction in February 2017.


A systematic chart review of 176 patients enrolled in the Cancer Survivorship Clinic (CSC) who completed a minimum of one follow-up visit after the initial baseline visit. This was assessed using three screening tools: distress thermometer (DT), Canadian Problem Checklist (CPC), and Edmonton Symptom Assessment Scale (ESAS). Descriptive statistics and t tests were utilized to assess the impact of the CSC.


Distress thermometer: Statistically significant decline in scores from the baseline visit to the follow-up visit among the study population (p < 0.05). There was a significant decline in score among high-risk patients with an initial DT≥4 (p < 0.0001). Canadian Problem Checklist: Based on the initial baseline visit, the top five reported causes of distress among the study population include pain, anxiety, fatigue, tingling in hands and feet, sleep. Edmonton Symptom Assessment Scale: Statistically significant decline in reported pain, tiredness, nausea, depression, anxiety, drowsiness, and shortness of breath scores (p < 0.05).


Overall, patients had a significant reduction in distress from the baseline visit to the follow-up visit. High-risk patients experienced a more significant reduction in distress. Reduction in patient distress was independent of the number of visits to the clinic. Reported symptom severity for pain, tiredness, depression, anxiety, drowsiness, and shortness of breath also declined significantly following clinic intervention. Further qualitative studies required to establish the clinical significance of study findings.

Implications for cancer survivors

Continued active clinical support and education for cancer survivors should be considered a potentially essential element in the cancer treatment trajectory to address patient well-being and distress.


Cancer Survivorship Primary care Distress Clinical practice guidelines Knowledge translation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study received approval through the William Osler Health System Research Ethics Board. This article does not contain any studies with human participants or animals performed by any of the authors. This is a systematic review that does not involve any contact with human participants. No informed consent is needed.


  1. 1.
    Ganz PA (2011) The “three Ps” of cancer survivorship care. BMC Med 9.
  2. 2.
    Suija K, Kordemets T, Annuk K, Kalda R (2016) The role of general practitioners in cancer care: a mixed method design. J Cancer Educ 31:136–141CrossRefGoogle Scholar
  3. 3.
    Hoekstra RA, Heins MJ, Korevaar JC (2014) Health care needs of cancer survivors in general practice: a systematic review. BMC Fam Pract 15:94CrossRefGoogle Scholar
  4. 4.
    Hewitt M, Greenfield S, Stovall E (2006) From cancer patient to cancer survivor: lost in transition. Washington, DCGoogle Scholar
  5. 5.
    Cheng KKF, Wong WH, Koh C (2016) Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors. Support Care Cancer 24:2025–2033CrossRefGoogle Scholar
  6. 6.
    Faller H, Koch U, Brahler E et al (2016) Satisfaction with information and unmet information needs in men and women with cancer. J Cancer Surviv 10:62–70CrossRefGoogle Scholar
  7. 7.
    National Comprehensive Cancer Network (NCCN) (2010) Clinical practice guidelines in oncology: distress management. Fort Washington, MarylandGoogle Scholar
  8. 8.
    Bultz BD, Groff SL, Fitch M, Blais MC, Howes J, Levy K, Mayer C (2011) Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice. Psychooncology 20:463–469CrossRefGoogle Scholar
  9. 9.
    Holland JC, Anderson B, Breitbart WS et al (2010) Distress management. J Natl Compr Cancer Netw 5:66–98Google Scholar
  10. 10.
    Kennard BD, Stewart SM, Olvera R, Bawdon RE, Hailin AO, Lewis CP, Winick NJ (2004) Nonadherence in adolescent oncology: preliminary data on psychological risk factors and relationships to outcome. J Clin Psychol Med Settings 11:30–39CrossRefGoogle Scholar
  11. 11.
    Von Essen L, Larsson G, Oberg K, Sjödén PO (2002) ‘Satisfaction with care’: associations with health related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumors. Eur J Cancer Care (Engl) 11:91–99CrossRefGoogle Scholar
  12. 12.
    Steel JL, Geller DA, Gamblin TC, Olek MC, Carr BI (2007) Depression, immunity, and survival in patients with hepatobiliary carcinoma. J Clin Oncol 25:2397–2405CrossRefGoogle Scholar
  13. 13.
    Hui D, Bruera E (2017) The Edmonton Symptom Assessment System 25 years later: past, present and future developments. J Pain Symptom Manag 53:630–643CrossRefGoogle Scholar
  14. 14.
    Cancer Journey Action Group (2009) Guide to implementing screening for distress, the 6th vital sign: moving towards person-centred care (part a). Toronto, OntarioGoogle Scholar
  15. 15.
    Howell D, Keller-Olaman S, Oliver TK, Hack TF, Broadfield L, Biggs K, Chung J, Gravelle D, Green E, Hamel M, Harth T, Johnston P, McLeod D, Swinton N, Syme A, Olson K (2013) A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue. Curr Oncol 20:233–246CrossRefGoogle Scholar
  16. 16.
    Linden W, Yi D, Barroetavena MC, MacKenzie R, Doll R (2005) Development and validation of a psychosocial screening instrument for cancer. Health Qual Life Outcomes 3:54CrossRefGoogle Scholar
  17. 17.
    Nekolaishuk C, Watanbe S, Beaumont C (2008) The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991-2006). Palliat Med 22:111–122CrossRefGoogle Scholar
  18. 18.
    Cancer Care Ontario (2004) Telephone nursing practice and symptom management guidelines. Toronto, OntarioGoogle Scholar
  19. 19.
    Cancer Care Ontario (2005) Palliative care collaborative care plan: fatigue (cancer patients). Toronto, OntarioGoogle Scholar
  20. 20.
    Oldenmenger WH, de Raaf PJ, de Klerk C, van der Rijt CC (2013) Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Sympton Assessment Scale in cancer patients: a systematic review. J Pain Symptom Manag 45:1083–1093CrossRefGoogle Scholar
  21. 21.
    Feldstain A, Tomei C, Bélanger M, Lebel S (2014) Screening for distress in patients with cancer: methodologic considerations. Curr Oncol 21:330–333CrossRefGoogle Scholar
  22. 22.
    Howell D, Hack TF, Oliver TK et al (2011) Survivorship services for adult cancer populations: a pan-Canadian guideline. Curr Oncol 18:e265–e281Google Scholar
  23. 23.
    Fitch MI (2000) Supportive care for cancer patients. Hosp Q 3:39–46Google Scholar
  24. 24.
    About Wellspring. Wellspring. Accessed 27 Oct 2018
  25. 25.
    O’Donnell E (2013) The distress thermometer: a rapid and effective tool for the oncology social worker. Int J Health Care Qual Assur 26:353–359CrossRefGoogle Scholar
  26. 26.
    VanHoose L, Black LL, Doty K, Sabata D, Twumasi-Ankrah P, Taylor S, Johnson R (2015) An analysis of the distress thermometer problem list and distress in patients with cancer. Support Care Cancer 23:1225–1232CrossRefGoogle Scholar
  27. 27.
    Olesen ML, Hansen MK, Hansson H, Ottesen B, Andersen KK, Zoffmann V (2018) The distress thermometer in survivors of gynaecological cancer: accuracy in screening and association with the need for person-centred support. Support Care Cancer 26:1143–1150CrossRefGoogle Scholar
  28. 28.
    Jacobsen PB, Donovan KA, Trask PC, Fleishman SB, Zabora J, Baker F, Holland JC (2005) Screening for psychologic distress in ambulatory cancer patients. Cancer 103:1494–1502CrossRefGoogle Scholar
  29. 29.
    Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Rapid screening for psychologic distress in men with prostrate carcinoma. Cancer 82:1904–1908CrossRefGoogle Scholar
  30. 30.
    Ma X, Zhang J, Zhong W, Shu C, Wang F, Wen J, Zhou M, Sang Y, Jiang Y, Liu L (2014) The diagnostic role of a short screening tool – the distress thermometer: a meta-analysis. Support Care Cancer 22:1741–1755CrossRefGoogle Scholar
  31. 31.
    Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2013) Validation for the distress thermometer worldwide: state of the science. Psychooncology 23:241–250CrossRefGoogle Scholar
  32. 32.
    Howell D, Olsen K (2011) Distress – the 6th vital sign. Curr Oncol 18:208–210Google Scholar
  33. 33.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Cancer 88:226–237CrossRefGoogle Scholar
  34. 34.
    Cancer Journey Portfolio (2012) Screening for distress, the 6th vital sign: a guide to implementing best practices in person-centred care. Toronto, OntarioGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Corporate ResearchWilliam Osler Health SystemBramptonCanada
  2. 2.Division of Palliative CareWilliam Osler Health SystemBramptonCanada
  3. 3.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of Family MedicineMcMaster UniversityHamiltonCanada
  5. 5.The Global Institute of Psychosocial, Palliative and End-of-Life CareUniversity of TorontoTorontoCanada

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