The oncology field is confronting three forces simultaneously:
- A rapidly growing population of long-term survivors,
- More patients living with advanced cancers once deemed incurable, and
- The rise of early-onset cancers.
These trends demand a paradigm shift. Survivorship is no longer a peripheral phase of care; it is a central and defining component of modern oncology.
While most cancer centers excel in guiding patients through acute treatment, what distinguishes City of Hope is our unwavering commitment to patients from the moment of diagnosis through long-term survivorship. During this time, patients face evolving health needs that require coordinated, anticipatory, and longitudinal care.
Transitioning into the post-treatment years introduces new risks but also a critical opportunity to optimize health and quality of life.
The late effects we fail to detect
Across the country, late effects of cancer therapy remain under-recognized, including subsequent primary malignancies and cardiovascular disease. These risks are driven by prior treatment exposures, genetic susceptibility, and aging, with cardiovascular complications, such as heart failure, coronary artery disease, and stroke often manifesting earlier than expected, relative to the general population.
Although these risks are well-documented in the field of cardio-oncology, they are frequently under-recognized in routine practice, where providers may not anticipate serious cardiovascular events in survivors in their 20s, 30s or 40s. At City of Hope, our cardio-oncology center of excellence integrates risk-based screening into routine survivorship care, enabling proactive management of near- and long-term risk.
Designing survivorship care that evolves with the patient
City of Hope’s Childhood, Adolescent and Young Adult Cancer Survivorship Program launched in the early 2000s. It was built around a simple recognition: Young people survive aggressive therapy at increasing rates, but their developing bodies make them uniquely vulnerable to late effects.
Our survivorship program follows patients longitudinally and integrates individualized, exposure-informed care with a robust research infrastructure. Survivors receive tailored evaluations, including cardiac imaging for those exposed to anthracyclines, breast cancer screening for women who received chest radiation, and assessment of bone density and metabolic health to prevent or detect complications early. This program now represents one of the largest longitudinal survivor cohorts and serves as a blueprint for City of Hope’s next phase.
Scaling survivorship across a national system
Too often survivorship programs in the U.S. exist primarily to satisfy accreditation requirements. With nearly 20 million cancer survivors nationwide, incremental compliance is no longer sufficient. Survivorship must be a fully integrated system of care.
The essential first step is ensuring survivors know their diagnosis, their treatment exposures, and the late effects they should anticipate. Many do not. We aim to change that.
City of Hope is expanding its Los Angeles survivorship program across the nation by leveraging an established hub-and-spoke model. We centralize survivorship leadership at our national medical center in Los Angeles while extending navigation, education and risk-based care outward through telehealth, remote monitoring, and coordinated clinical workflows.
The essential first step is ensuring survivors know their diagnosis, their treatment exposures, and the late effects they should anticipate. Many do not. We aim to change that.
Pairing care with research to transform future treatments
One of the greatest strengths of City of Hope’s Childhood, Adolescent and Young Adult Survivorship Program has been the marriage of clinical care with research. Survivors complete comprehensive health questionnaires and contribute blood samples to help identify genetic drivers and biological mechanisms underlying late effects.
This integrated partnership accelerates the development of more effective, less toxic therapies, enabling future patients to benefit directly from the lived experience of survivors.
At City of Hope, our charge is to care for patients from diagnosis through survivorship—and to learn from them to continually improve cancer therapy. Our goal is not only longer lives, but better ones.
City of Hope® is one of the largest and most advanced cancer research and treatment organizations in the U.S. To learn more about City of Hope, visit: www.cityofhope.org. Discover the latest innovations in cancer research on City of Hope’s new podcast, “On the Edge of Breakthrough: Voices of Cancer Research.” Available on Spotify, Apple Podcasts, and at cityofhope.org/edge-of-breakthrough.
