Excerpts of interview by Carol Bryce of Alma Rodriguez, M.D., vice president for medical affairs.

At M. D. Anderson, we're defining cancer survivorship, in accordance with the official definition by the National Cancer Institute's Office of Survivorship, as beginning at the time of disease diagnosis and continuing throughout the rest of the patient's life.

There are, however, different stages and phases of cancer survivorship, each with unique clinical care needs. The acute phase is the period of diagnosis and treatment; the intermediate phase is the period of observation and monitoring post-treatment, when probability of recurrence is high and long-term survivorship is beyond that threshold of highest risk of recurrence. These phases can be different in duration depending upon the cancer type and the stage of disease at diagnosis.

Our objective is to be sure we've met the needs of the patient based upon his or her particular phase of survivorship. We're obviously most focused and expert at acute and intermediate cancer care. But once a patient gets past those phases, we assume that the patient is well and ready to get back to life. Unfortunately, that’s not always true.

Long-term cancer survivors have many different issues to deal with. Some patients may still be at risk of latent side effects years after they were first treated. Some malignancies also have patterns in which there are periodic recurrences and thus patients move back from long-term survivorship to acute treatment at different time points. Survivorship care should be designed to help patients deal with latent side effects or prepare them for relapse periods.

That means we need a whole new set of providers, including people who can deal with patients' psychosocial needs and general health maintenance issues. We need to shift from dealing with acute disease management issues to looking at health maintenance issues. This takes educating patients and providers, both at M. D. Anderson and in the community.