Cancer Survivors in the United States: A Review of the Literature and a Call to Action

Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48106, USA.
International journal of medical sciences (Impact Factor: 2). 01/2012; 9(2):163-73. DOI: 10.7150/ijms.3827
Source: PubMed

ABSTRACT The number of cancer survivors in the U.S. has increased from 3 million in 1971, when the National Cancer Act was enacted, to over 12 million today. Over 70% of children affected by cancer survive more than 10 years, and most are cured. Most cancer survivors are adults, with two-thirds of them 65 years of age or older and two-thirds alive at five years. The most common cancer diagnoses among survivors include breast, prostate and colorectal cancers. This review was conducted to better appreciate the challenges associated with cancer survivors and the opportunities healthcare providers have in making a difference for these patients.
Comprehensive review of literature based on PubMed searches on topics related to cancer survivorship, and associated physical, cognitive, socio-economic, sexual/behavioral and legal issues.
At least 50% of cancer survivors suffer from late treatment-related side effects, often including physical, psychosocial, cognitive and sexual abnormalities, as well as concerns regarding recurrence and/or the development of new malignancies. Many are chronic in nature and some are severe and even life-threatening. Survivors also face issues involving lack of appropriate health maintenance counseling, increased unemployment rate and workplace discrimination.
Advances in the diagnosis and treatment of cancer will lead to more survivors and better quality of life. However, tools to recognize potentially serious long-lasting side effects of cancer therapy earlier in order to treat and/or prevent them must be developed. It is incumbent upon our health care delivery systems to make meeting these patients' needs a priority.

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Available from: Ann M Kujawa, Sep 29, 2015
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    • "Unfortunately, the therapeutic potential of ANTs is limited by their cumulative dose-dependent cardiotoxicity (i.e., cardiomyopathy and congestive heart failure). The delayed cardiotoxicity of ANTs most likely appears many years later and affects treatment efficacy (Valdivieso et al., 2012). New derivatives, such as epirubicin (EPI) and pirarubicin (PIRA) (Fig. 1), "
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    ABSTRACT: Drug-induced cardiotoxicity is a leading factor for drug withdrawals, and limits drug efficacy and clinical use. Therefore, new alternative animal models and methods for drug safety evaluation have been given great attention. Anthracyclines (ANTs) are widely prescribed anticancer agents that have a cumulative dose relationship with cardiotoxicity. We performed experiments to study the toxicity of ANTs in early developing zebrafish embryos, especially their effects on the heart. LC50 values for daunorubicin, pirarubicin, doxorubicin (DOX), epirubicin and DOX-liposome at 72 h post-fertilization were 122.7 μM, 111.9 μM, 31.2 μM, 108.3 μM and 55.8 μM, respectively. At the same time, zebrafish embryos were exposed to ANTs in three exposure stages and induced incomplete looping of the heart tube, pericardia edema and bradycardia in a dose-dependent manner, eventually leading to death. DOX caused the greatest heart defects in the treatment stages and its liposome reduced the effects on the heart, while daunorubicin produced the least toxicity. Genes and proteins related to heart development were also identified to be sensitive to ANT exposure and downregulated by ANTs. It revealed ANTs could disturb the heart formation and development. ANTs induced cardiotoxicity in zebrafish has similar effects in mammalian models, indicating that zebrafish may have a potential value for assessment of drug-induced developmental cardiotoxicity. Copyright © 2014 John Wiley & Sons, Ltd.
    Journal of Applied Toxicology 05/2014; 35(3). DOI:10.1002/jat.3007 · 2.98 Impact Factor
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    • "Surgery and adjuvant treatment such as chemotherapy, radiotherapy and endocrine therapy have all contributed to the improved survival. These treatments can, however, alone or in combination have a negative impact on the daily life and wellbeing of the breast cancer survivors [2] [3]. Despite the fact that up to 80% of younger breast cancer survivors usually can continue to work after treatment, late effects such as fatigue, lymph oedema, arm and shoulder problems, depression and cognitive problems have all been reported by breast cancer survivors in work [4] [5] [6]. "
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    ABSTRACT: Aim: Though about 20% of working age breast cancer survivors do not return to work after treatment, few studies have addressed risk factors for unemployment. The majority of studies on occupational consequences of breast cancer focus on non-employment, which is a mixture of sickness absence, unemployment, retirement pensions and other reasons for not working. Unemployment in combination with breast cancer may represent a particular challenge for these women. The aim of the present study is therefore to analyze the risk for unemployment in the years following diagnosis and treatment for breast cancer. Method: This study included 14,750 women diagnosed with breast cancer in Denmark 2001-2009 identified through a population-based clinical database and linked with information from Danish administrative population based registers for information on labour market affiliation, socio-demography and co-morbid conditions. Multivariable analyses were performed by Cox's proportional hazard models. Results: Two years after treatment, 81% of patients were still part of the work force, 10% of which were unemployed. Increasing duration of unemployment before breast cancer was associated with an adjusted HR = 4.37 (95% CI: 3.90-4.90) for unemployment after breast cancer. Other risk factors for unemployment included low socioeconomic status and demography, while adjuvant therapy did not increase the risk of unemployment. Conclusions: Duration of unemployment before breast cancer was the most important determinant of unemployment after breast cancer treatment. This allows identification of a particularly vulnerable group of patients in need of rehabilitation.
    Scandinavian Journal of Public Health 01/2014; 42(3). DOI:10.1177/1403494813520354 · 1.83 Impact Factor
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    • "Further, survivors of adult, AYA, and pediatric cancers are at risk for recurrence and subsequent malignancies. Relative to the US population, survivors experience excess morbidity and mortality due to cardiac and vascular abnormalities and pulmonary complications (Choi et al., 2011; Mariotto et al., 2007; Oeffinger and Tonorezos, 2011; Siegel et al., 2012a; Valdivieso et al., 2012). This landscape highlights an opportunity to use PNI paradigms to understand cancer from a competing risk perspective in which multiple factors concurrently affect risks for morbidity and mortality (Mell et al., 2010; Schairer et al., 2004). "
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    ABSTRACT: This article introduces the supplemental issue of "Cancer, Brain, Behavior, and Immunity" and outlines important discoveries, paradigm shifts, and methodological innovations that have emerged in the past decade to advance mechanistic and translational understanding of biobehavioral influences on tumor biology, cancer treatment-related sequelae, and cancer outcomes. We offer a heuristic framework for research on biobehavioral pathways in cancer. The shifting survivorship landscape is highlighted and we propose that the changing demographics suggest prudent adoption of a life course perspective of cancer and cancer survivorship. We note opportunities for psychoneuroimmunology (PNI) research to ameliorate the long-term, unintended consequences of aggressive curative intent and call attention to the critical role of reciprocal translational pathways between animal and human studies. Lastly, we briefly summarize the articles included in this compilation and offer our perspectives on future research directions.
    Brain Behavior and Immunity 01/2013; 30. DOI:10.1016/j.bbi.2013.01.003 · 5.89 Impact Factor
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