Individuals who receive a cancer diagnoses as children
or adolescents, or young adult are not the only group
extremely vulnerable to treatment-related health issues.
;e elderly are also particularly susceptible to the toxic
e;ects of many treatments for myriad reasons, including
the presence of other health conditions normally associated
with aging, such as poor heart function and type II diabetes.
Fortunately, outcomes for the elderly have signi;cantly
improved advances in surgery, radiotherapy, and palliative
care, along with the advent of the molecularly targeted
therapeutics era. However, a need still exists for e;ective
methods of predicting therapeutic toxicities in the elderly,
and recent research has made inroads in developing some
models that could help in this regard (139). Undoubtedly,
continued research will only further advance our ability to
e;ectively treat our most at-risk populations.
A major concern for all cancer survivors is the return of
their cancer or the development of a new cancer. Just as a
healthy approach to living can prevent the development
of cancer, it can also help prevent a cancer recurrence
(see Healthy Living Can Prevent Cancer From Developing,
Progressing, or Recurring, p. 14). For example, emerging
evidence indicates that regular, intense aerobic exercise can
reduce recurrence and mortality in early breast, prostate,
and colorectal cancer survivors (140). However, adopting
healthy approaches to living can be as di;cult for cancer
survivors as it is for otherwise healthy individuals. More
research is necessary to understand how best to help modify
behaviors to embrace healthy living approaches.
In addition to adopting healthy living approaches, some
cancer patients receive treatment for a time a;er their initial
therapy is complete to help decrease their risk for tumor
recurrence and metastasis emergence, thereby increasing
their chance of long-term survival. ;is approach is called
adjuvant therapy, and it can be any form of anticancer
therapeutic or radiotherapy.
Although the concept of adjuvant therapy is not new, it is
becoming more common because many new anticancer
therapeutics are better tolerated, although not completely
without side e;ects. As a result, patients may be able to
take them for longer periods. Whether a patient receives
adjuvant therapy depends on a number of factors, including
the stage of disease and other factors that may categorize a
tumor as having a higher risk of recurrence. A clinician can
prescribe adjuvant treatment for nearly any form of cancer;
however, it is most commonly prescribed for high-risk
forms of breast cancer, colorectal cancer, melanoma, and
some gynecologic cancers.
Recent research has identi;ed a potential new adjuvant
therapy approach to decreasing tumor recurrence for
patients with hormone receptor–positive breast cancer
(141). Speci;cally, results from two large-scale clinical
trials showed that inclusion of an antiestrogen therapeutic
called exemestane, as part of a ;ve-year course of adjuvant
therapy, decreased cancer recurrence in premenopausal
women with breast cancer fueled by estrogen (141).
Given that research has shown that about one in four cancer
survivors has a decreased quality of life owing to physical
problems and one in 10 owing to emotional problems
(142), it is clear that much more research is needed to help
the growing number of cancer survivors achieve a higher
quality of life.
One issue that a;ects many women who survive cancer is
infertility. Fortunately, a large-scale clinical trial recently
reported promising results that may help preserve
fertility for some of the 15 percent of premenopausal
women diagnosed with breast cancer who have tumors
that do not have hormone receptors or other molecules
that can be targeted with precise therapeutics. ;e only
therapeutics available to these patients are traditional
chemotherapeutics, which frequently cause infertility by
damaging the ovaries. In this clinical trial, women who were
treated with a therapeutic called goserelin (Zoladex), which
shuts down their ovaries, putting them into temporary
menopause while they received chemotherapy, were almost
twice as likely to have a normal pregnancy a;er their cancer
treatment compared with women who did not receive
goserelin (143).
;ese research advances provide new hope for
premenopausal women who are cancer survivors.
Unfortunately, these individuals form only a small
proportion of the U.S. cancer survivor population and the
advances address only some of the challenges faced by these
patients. Further progress toward reducing the impact of
cancer treatment on cancer survivors in the future will take
a concerted e;ort from all stakeholders in the biomedical
research community (see sidebar on The Biomedical
Research Community, p. 2).
To address this need, a number of professional societies
and not-for-profit organizations have recently developed
clinical-practice guidelines that are designed to improve
the prevention and management of some of the health-related issues affecting cancer survivors, including
fatigue, anxiety and depression, and sexual dysfunction
(144-146). Advocacy organizations, such as the Women
Survivor Alliance, cofounded by Karen Shayne and Judy
Pearson (see p. 78), also have an integral role to play if
we are to meet the needs of cancer survivors, their loved
ones, and future men, women, and children navigating
the cancer journey.
