Trends and advances in cancer survivorship research: challenge and opportunity1
Section snippets
Definitional issues
Fitzhugh Mullan,14 a physician diagnosed with and treated for cancer himself, first described cancer survivorship as a concept. Definitional issues for cancer survivorship encompass 3 related aspects:
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Who is a cancer survivor? Philosophically, anyone who has been diagnosed with cancer is a survivor, from the time of diagnosis to the end of life (from the National Coalition for Cancer Survivorship). Caregivers and family members are also included within this definition as secondary survivors.
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The evolving paradigm of cancer survivorship research
Consistent with the shift in our perceptions of cancer as a chronic disease, new perspectives, and an emerging body of scientific knowledge must now be incorporated into Mullan’s original description of the survivorship experience.19 Mullan’s comparison of cancer survivorship with “seasons of the year” had implied that the availability and widespread use of curative and effective treatments would lead to a low likelihood of recurrence and longer survival times. However, the potential impact of
Prevalence data for cancer survivors
Cancer survival has risen steadily over the past 3 decades for all cancers combined. Prevalence proportions estimated from cancer incidence and follow-up data in the Surveillance, Epidemiology, and End Results (SEER) registry indicate that there are currently 8.9 million cancer survivors in the United States alone (nonmelanoma skin cancer and in situ diseases are excluded from this estimate), representing 3.3% of the entire US population.21, 22 As past and future advances in cancer detection,
Implications of the data
Most survivors can expect to cross the 5-year mark, and, for many, cancer has become a chronic illness. However, although our understanding of the causes of differences in cancer incidence and mortality in diverse populations is growing rapidly, the effect of diagnosis and treatment on those who continue to survive and live with their disease is less clear. Survival disparities exist across ethnocultural minority and medically underserved groups. The demography of cancer survivorship is
Long-term cancer survivors: research needs and issues in a growing yet understudied portion of the survivorship continuum
Although cancer survivors are living longer, we have limited knowledge and many questions about the health status, functioning, and quality of life for most of those who have been post-treatment for long periods of time. What are the most common late effects of treatment? Who is at risk and can they be protected? Can treatment-related injury to normal tissue be prevented or reversed? What proportion of survivors will experience recurrent or second malignancies? Who should be following these
Physiologic late effects
Most cancer treatments carry substantial risk of adverse long-term or late effects, including neurocognitive problems, premature menopause, cardiac dysfunction, sexual impairment, chronic fatigue and pain syndromes, and second malignancies for both adult and childhood cancer survivors.56, 57 One fourth to one third of breast and lymphoma survivors who receive chemotherapy may develop detectable neurocognitive deficits,58, 59, 60 and late clinical cardiotoxicity, often life threatening, may
Discussion
Cancer survivorship research continues to provide us with a growing body of evidence regarding the unique and uncharted consequences of cancer and its treatment among those diagnosed with this disease. It is becoming an acknowledged fact that most cancer treatment options available and in use today will affect the future health and life of those diagnosed with this disease. Adverse cancer treatment-related sequelae thus carry the potential to contribute to the ongoing burden of illness, health
Conclusion
A large and growing community of cancer survivors is one of the major achievements of cancer research over the past 3 decades. Both length and quality of survival are important endpoints. Many cancer survivors are at risk for and develop physiologic and psychosocial late and long-term effects of cancer treatment that may lead to premature mortality and morbidity. As in the past when treatments were modified to decrease the chance of toxicities in childhood cancer survivors, the goal of future
References (100)
Late effects of cancer and its treatment
Semin Oncol Nurs
(2001)- et al.
Cancer survivors
Primary Care
(1992) Cancer survivorship researchChallenge and opportunity
J Nutr
(2002)- et al.
The changing face of cancer survivorship
Semin Oncol Nurs
(2001) Effects of cancer on the sexuality and fertility of women
Semin Oncol Nurs
(1995)- et al.
Post trauma symptoms in childhood leukemia survivors and their parents
Psychosomatics
(1996) - et al.
Reduced pulsatile growth hormone secretion in children after therapy for acute lymphoblastic leukemia
J Pediatr
(1984) - et al.
High incidence of obesity in young adults after treatment of acute lymphoblastic leukemia in childhood
J Pediatr
(1995) - et al.
Final height after treatment for childhood acute lymphoblastic leukemiaComparison of no cranial irradiation with 1,800 and 2,400 centigrays of cranial irradiation
J Pediatr
(1993) - et al.
Reproductive sequelae of cancer treatment
Obstet Gynecol Clin North Am
(1998)
The evolution and application of toxicity criteria
Semin Radiat Oncol
Cancer Facts and Figures, 2003
Cancer incidence and survival among children and adolescentsUnited States SEER program 1975–1995
Long-term survivorshipLate effects
Recent trends in U.S breast cancer incidence, survival, and mortality rates
J Natl Cancer Inst
Declining cancer rates in the 1990s
J Clin Oncol
The annual report to the nation on the status of cancer, 1973-1997, with a special section on colorectal cancer
Cancer
Long term survivors of childhood leukemia
Curr Opin Hematol
Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas
Cancer
Long-term survivors of childhood cancerThe late effects of therapy
Oncologist
The economic burden of cancer
Overview of the effects of cancer therapiesThe nature, scale and breadth of the problem
Acta Paediatr
Seasons of survivalReflections of a physician with cancer
N Engl J Med
Surviving adult cancers. Part 1Physiologic effects
Ann Intern Med
Surviving adult cancers. Part 2Psychosocial implications
Ann Intern Med
Long-term survivors of childhood cancer. The medical consequences of cure
Pediatr Clin North Am
Late effects of childhood cancer and its treatment
SEER Cancer Statistics Review, 1973–1997
Cancer Care Issues in the United StatesQuality of Care, Quality of Life 1998 National Cancer Program
Cancer survivorship research among ethnic minority and medically underserved groups
Oncol Nurs Forum
Survivorship and rehabilitation
The human costs of cancer and the response of the National Cancer Program
Cancer
Imperatives for Quality Care Access, Advocacy, Action and Accountability
Psychosocial problems in cancer survivors
Oncology
Is psychological well being impaired in long term survivors of breast cancer
J Med Screening
Predicting psychosocial risk in patients with breast cancer
Med Care
Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood
N Engl J Med
Cardiac failure and dysrhythmias 6-19 years after anthracycline therapyA series of 15 patients
Med Pediatr Oncol
Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancerHigh-dose versus standard-dose chemotherapy
JNCI
Cognitive function in breast cancer patients receiving adjuvant chemotherapy
J Clin Oncol
Comparison of neuropsychologic function and clinical indicators of neurotoxicity in long-term survivors of childhood leukemia given cranial irradiation or parenteral methotrexateA prospective study
J Clin Oncol
Neurobehavioral functioning and quality of life in patients treated for cancer of the central nervous system
Curr Opin Oncol
Managing menopausal symptoms in breast cancer survivorsResults of a randomized controlled trial
J Natl Cancer Inst
Factors related to sexual function in postmenopausal women with a history of breast cancer
Menopause
Risk of menopause during the first year after breast cancer diagnosis
J Clin Oncol
Hyperprolactinemia and hypothyroidism following cytotoxic therapy for central nervous system malignancies
J Clin Oncol
Off-treatment fatigue in breast cancer survivorsA controlled comparison
J Behav Med
Hodgkin’s disease survivors more fatigued than the general population
J Clin Oncol
Breast cancer and other second neoplasms after childhood Hodgkin’s disease
N Engl J Med
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The ongoing need for research among long-term survivors of cancer is identified as a key initiative within the new Cancer Survivorship Extraordinary Opportunity for Research Investment - FY 2004 Bypass Budget of the National Cancer Institute.