Cancer Survivorship
According to the NCI, a cancer survivor is anyone living with,
through or beyond a cancer diagnosis. Over the past several
decades, tremendous advances have been made in the field of
cancer research, and as a result, a large and growing community of
cancer survivors now exists. For example, prior to 1970, being
diagnosed with cancer during childhood was considered a
universally fatal disease, whereas there are now approximately
300,000 survivors of pediatric cancer in the U.S, and the five-year
survival rate is over 80%. Progress has been made against many
other cancers as well, and the number of people living today with a
history of cancer has risen to over 13. 7 million — a significant
increase from the 3 million survivors living in 1971( 1).
Long-term survivorship is also increasing: in the U.S. in 2012, an
estimated 64% survivors were diagnosed with cancer five or more
years ago and 15% were diagnosed 20 or more years ago. Nearly
50% of the current survivor population is 70 years of age or older,
while only 5% are younger than 40. Earlier cancer detection and
more effective treatments, along with the aging population, are
expected to further increase the number of individuals living well
beyond a cancer diagnosis.
While rising survivorship in and of itself is a sign of progress against
cancer, survivors may suffer serious and persistent long-term
adverse outcomes. Cancer survivors are at increased risk for and
develop psychosocial and physiologic long-term and late effects of
cancer treatment, including but not limited to: anxiety, depression,
fear of cancer recurrence, damage to the heart, lung and kidney,
cognitive impairment and infertility. Additionally, survivors are at risk
for recurrence of the original cancer or the development of a new,
biologically distinct, second primary cancer.
Adolescent and young adult oncology (AYAO) survivors, age 15–39
years, along with pediatric cancer survivors, face a unique set of
challenges compounded by their stage of life. For the AYAO
population, two out of every three childhood cancer survivors will
develop at least one complication due to their prior therapy, and one
out of every three will develop serious or life-threatening
complications. Further, recent studies have concluded that AYAO
survivors are at higher risk for engaging in risky health behaviors
known to increase cancer risk, such as smoking and drinking,
which puts them at higher risk for developing additional
cancers (133).
Following treatment, a person diagnosed with cancer may be faced
with critical problems that diminish quality of life. The new research
focus on cancer survivorship promises to play a significant role in
the reduction of long-term and late effects. After decades of focus
on cancer treatments and the attendant successes emerging from
those efforts, researchers now face the challenge of helping the
increased number of survivors achieve a higher quality of life by
avoiding or diminishing the potential late adverse health
consequences of successful therapies. By gaining a better
understanding of the issues confronting cancer survivors, the
cancer research community can continue to play an integral role in
meeting the needs of survivors, their loved ones and future
Americans diagnosed with this dreaded disease.
Although high-dose radiation therapy is clearly beneficial for cancer
treatment, patients are at increased risk for developing a second
cancer, particularly pediatric patients. Given that the number of
cancer survivors in the U.S. alone is now estimated at more than
13. 7 million ( 3), this is a growing concern (see Sidebar on Cancer
Survivorship). Research is needed to determine ways to identify
those patients who are most sensitive to the negative health effects
of radiation.
Environmental Pollutants: A Murky Link to Cancer
The identification of environmental and workplace agents that cause
cancer continues to be an important area of epidemiological and
toxicological research. One of the most well-established links
between an environmental pollutant and cancer is that between
inhalation of asbestos and mesothelioma ( 41), an aggressive form of
cancer for which new treatment options are urgently needed. The
scientific determination of this causal relationship led to the use of
preventive interventions and the implementation of important public
health policies. However, asbestos remains a relevant risk factor
today because it is still used in some commercial products within
the U.S. In addition, not all the asbestos used in the last century has
been removed. Moreover, erionite, a natural mineral fiber from
volcanic ash that is similar to asbestos, is more potent than
asbestos in causing mesothelioma and has been used in paving
products in certain parts of the U.S. ( 42).
Many other environmental agents are classified as “likely to be
cancer-causing” or “known to be carcinogenic” ( 41, 43). These
agents include arsenic; pesticides; solvents used in the dry-
cleaning industry and in paint thinners, paint and grease removers;
dioxins, which are unwanted byproducts of chemical processes
such as paper and pulp bleaching; polycyclic aromatic
hydrocarbons, which primarily come from burning wood and fuel for
homes but are also contained in gasoline and diesel exhaust; and
heavy metals like those contained in rechargeable batteries. Further
not only does tobacco use cause cancer,
but there is a 5% reduction in
the effectiveness of cancer treatment
while smoking?
