Muna Al-Khaifi, Lead of Breast Cancer Survivorship Program and GP Oncologist at the Skin Cancer Clinic at Sunnybrook, presents this article as part of a series on rethinking survivorship care. This piece explores the importance of integrating survivorship principles early in the cancer continuum, emphasizing a shift from reactive, post-treatment care to proactive, continuous, and multidisciplinary support beginning at diagnosis.
“The Importance of Early Integration of Survivorship Care Across the Cancer Continuum
Rethinking when survivorship care begins-and how earlier integration may support proactive care and improve overall patient outcomes and quality of life.
As the number of cancer survivors continues to rise globally, there is an increasing need to rethink when and how survivorship care is delivered. Traditionally, survivorship has been viewed as a phase that begins after the completion of active treatment. However, this approach fails to reflect the reality that many cancer-related symptoms and challenges emerge at diagnosis and persist throughout treatment and beyond.
Survivorship should not be understood as an identity label, but rather as a clinical and care framework that enables healthcare systems to recognize and respond to patient needs across the entire cancer trajectory-from diagnosis to end of life.
Using survivorship as a framework allows healthcare professionals to:
- Recognize that cancer-related needs begin at diagnosis.
- Address symptoms during treatment, not only after.
- Focus on long-term and late effects, including fatigue, menopause-related symptoms, and cognitive changes.
- Ensure continuity of care across all disease stages, including metastatic cancer.
- Advocate for structured care models beyond acute oncology.
Why Early Integration Matters
Evidence consistently shows that symptom burden is highest during and immediately following treatment-not only in the post-treatment phase. Early risk identification enables clinicians to intervene before complications become established.
A clear example is lymphedema. Early surveillance, including baseline limb measurements and patient education, allows clinicians to detect subtle changes and implement preventive strategies. Interventions such as physiotherapy, exercise, and lymphatic drainage can significantly reduce progression and improve long-term outcomes. This approach shifts care from reactive management to proactive prevention.
Another important model is prehabilitation-interventions initiated before treatment to optimize physical and psychological readiness. These programs often include exercise, nutrition, and psychological support. Patients who begin treatment in better condition are more likely to tolerate therapy, experience fewer complications, and recover more efficiently.
Early integration also allows for timely psychosocial and informational support. A cancer diagnosis is often accompanied by uncertainty and distress, and many patients feel unprepared for treatment-related side effects. Providing education early-regarding symptoms, nutrition, and physical activity-empowers patients, reduces anxiety, and supports informed decision-making.
Importantly, integrating services such as physiotherapy, psychology, nutrition, and social work from the outset ensures care is coordinated and comprehensive. This multidisciplinary approach improves access to supportive services, enables timely intervention, and reduces fragmentation of care.
In practice, early integration of survivorship care requires structured and coordinated models of care. Patients can be assessed early in the disease trajectory to identify their individual risks and needs, allowing for timely intervention. Identifying a dedicated team member-such as a nurse navigator or survivorship coordinator-may help ensure continuity, streamline communication, and support patients in navigating complex healthcare systems.
Embedding survivorship care into routine clinical workflows, with clear pathways for referral and multidisciplinary collaboration, may further enhance care delivery and improve patient experience.
Beyond individual patient outcomes, early integration has important system-level benefits. Proactive management of symptoms may reduce hospitalizations, improve treatment adherence, and decrease healthcare utilization. In contrast, delayed care often leads to more complex and resource-intensive interventions later in the disease trajectory.
Extending Survivorship to Advanced Disease
Survivorship must also include individuals living with advanced or metastatic cancer. These patients have ongoing and evolving needs that extend beyond disease control, including symptom management, psychosocial support, and care coordination. Early integration ensures these needs are addressed continuously, rather than introduced too late in the care pathway. By framing survivorship as a dynamic and lifelong process, healthcare providers can deliver care that is responsive to changing patient needs.
Early integration of survivorship care represents a fundamental shift in how cancer care is delivered. Rather than waiting until treatment ends, this approach recognizes that patient needs begin at diagnosis and evolve over time.
The question is no longer whether survivorship care should begin early-but whether healthcare systems can afford not to implement it.
Failing to integrate survivorship care from the outset risks missed opportunities for prevention, delayed intervention, and avoidable declines in quality of life. In contrast, early and continuous survivorship care offers a proactive, patient-centered model that not only improves outcomes but redefines what high-quality cancer care should look
As cancer outcomes continue to improve, the definition of success in oncology must evolve beyond survival alone to include the quality of life patients experience with, through, and beyond cancer.
References
- American Society of Clinical Oncology. Management of fatigue in adult survivors of cancer: guideline update.
- Lustberg MB, et al. Mitigating long-term and delayed adverse events associated with cancer treatment. Nat Rev Clin Oncol. 2023.
- Chan RJ, et al. Integrated shared-care survivorship model (EMINENT trial). eClinicalMedicine. 2025.
- McLaughlin SA, et al. Advances in lymphedema prevention, detection, and management. ASCO Educational Book. 2020.
- Haroen H, et al. Early palliative care and quality of life outcomes in cancer patients. BMC Palliat Care. 2025.
Alkhaifi M et al.. Advancing survivorship care for metastatic cancer. Ann Palliat Med. 2025.”
You can also read Muna Al-Khaifi: A New Perspective on Cancer Survivorship Care
