Dr. Harshvardhan Atreya
Lucknow, February 4: The word “survivorship” is often used in several different ways. One common definition is a person without cancer after finishing treatment. Another common definition is the process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to receive treatment to either reduce the risk of the cancer coming back or to manage chronic disease.
The NCCN Survivorship Panel supports the NCI’s definition of a cancer survivor: “An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted and included in this definition and are therefore included in this definition.”
No matter how it is defined, survivorship is unique for every person. Everyone has to find his or her own path to navigate the changes and challenges that arise as a result of living with cancer.
A report issued by the US Centers for Disease Control and Prevention and the NCI and data from the American Cancer Society estimate that the number of cancer survivors in the United States increased from approximately 3 million in 1971 to 13.7 million in 2012. These numbers are predicted to reach almost 18 million by 2022. This striking increase is generally attributed to rising cancer incidence rates (mainly resulting from an aging population), earlier detection, and better treatment.
An analysis of the SEER database showed that 45% of survivors were 70 years of age or older in 2012. In fact, an estimated 1 of every 5 persons older than 65 years is a cancer survivor. Only 5% are younger than 40 years, and survivors of childhood cancer constitute between 0.5% and 3.0% of the survivor population. The most common cancer sites in the survivor population are breast, prostate, colon/rectum cancers, and melanoma, together accounting for approximately 60% of survivors.
The increasing population of cancer survivors presents several challenges and opportunities. Cancer survivors and caregivers have some of the same needs, and their needs change over time. The two most pressing challenges are meeting the needs of the growing population of older cancer survivors and providing care for survivors of childhood cancer who have treatment-related cancers and coexisting medical conditions.
The Effects of Cancer and Its Treatment
For some survivors, the consequences of cancer are minimal; these patients can return to a normal life after the completion of treatment. In fact, most cancer survivors report being in good general health and experience good to excellent quality of life.
However, many survivors do experience physical and/or psychosocial effects of cancer and its treatment. Some sequelae become evident during anti-cancer treatment (long-term effects), whereas others may not manifest for months or years after active therapy (late effects). The problems can range from mild to severe, debilitating, or even life threatening. Some problems are temporary or improve with time, whereas others problems are progressive or permanent.
A recent review suggests that at least 50% of survivors experience some late effects of cancer treatment. The most common problems in cancer survivors are depression, pain, and fatigue.
Physical Effects
Physical problems in cancer survivors include pain, musculoskeletal issues, fatigue, and lack of stamina, urinary/bowel problems, lymphedema, premature menopause, cognitive deficits, and sexual dysfunction. The effects of cancer treatment on the heart and bone are also well known.
Second Cancers
Importantly, subsequent malignant neoplasms commonly occur in survivors because of genetic susceptibilities (eg, cancer syndromes), shared causative exposures (eg, smoking, environmental exposures), and mutagenic effects of cancer treatment. Studies by individual cancer type show that the incidence of subsequent unrelated cancers ranges from 2% in survivors of malignant