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Baker et al. J Cancer Metastasis Treat 2020;6:24 I http://dx.doi.org/10.20517/2394-4722.2020.36 Page 9 of 12

Figure 3. Distribution of high-sensitivity C-reactive protein (hsCRP) measurement by age and positive risk factors

extended clinic visits, pre-visit patient care and post-visit documentation and creation of the survivorship
care plan. First visit preparation, face-to-face evaluation, and discussion routinely extend beyond 90 minutes,
though visit duration decreases with subsequent visits. We monitor the patient for increased awareness of
risk factors and are pleased to see improvement in many patients.

We suggest that patients with bone sarcoma and soft tissue sarcomas exposed to anthracycline
chemotherapy are best followed within a medical oncology setting. Medical oncologists have the expert
knowledge of sarcoma and sufficient familiarity of survivorship literature as well as the skills in the
principles and practice of internal medicine. For example, owing to the widespread use of tyrosine kinase
inhibitors oncologists have had to learn again the medical management of hypertension. Management of
these complex patients requires knowledge of the patient’s treatment history and associated complications,
management of the suite of chronic conditions that develop over time, and a foundational relationship
between the provider and the patient. It may be necessary to share these responsibilities with a willing
primary internist experienced in aggressive management of lipids, hypertension, diabetes, and obesity with
clear pathways of care coordination and communication. We have learned at our institution that those
trained in Med-Peds are most often receptive to a shared care model.

Benefits to these survivor patients not only can be measured in quality of life but also lifespan. Prevention
of catastrophic chronic medical conditions with active management strategies clearly benefits society
as well. The cost in time and resources in providing this care is challenging in the current climate of
minimizing return visits within oncology, reducing visit times, the utilization of extenders to conduct
follow-up care, and transiting patients to primary care for management of their chronic diseases. Medical
educators should be encouraged to modify medical or Med-Peds curricula to accommodate this growing
societal need as the population of cancer survivors continues to grow. Experts predict that there will be
more than 20 million cancer survivors by 2025. The cost of these practices to the patients as observed in
our clinic is that patients are not made aware of their risks of developing chronic diseases, are unaware that
they should be monitored for chronic diseases following treatment, especially at a young age, and are not
having their chronic diseases managed by anyone. The frequency of risk factors in younger survivors of our
clinic suggests that there is a window of opportunity to have a great impact on quality of life and longevity
among patients already burdened by the experience of cancer at a young age.