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INTRODUCTION

The impact of cancer extends well past initial diagnosis. Patients are significantly affected by cancer and treatment-related toxicities often extending beyond the initial treatment period. Adult survivors of childhood, adolescent, and young adult cancer face special health consequences of cancer treatment related to premature physiologic aging and frailty. More than 40% of these patients will experience a severe, disabling, or life-threatening condition or die of a chronic condition. Long-term effects include toxicities that emerge during therapy and continue beyond treatment, while late effects include toxicities that may not emerge for months or years after treatment. Significant improvements in cancer treatments have enabled more people to survive once-deadly diseases, leading to more cancer survivors subjected to the potential long-term impact of cancer treatment (Table 95-1 lists potential long-term and late effects of cancer therapy by organ system). The direct causality of emerging treatments may not be immediately evident, and pharmacovigilance remains critical after treatments first become approved.

TABLE 95-1Organ Systems at Risk for Long-Term and Late Effects of Cancer Treatment

In the United States, the number of cancer survivors may increase from 17 million to nearly 26 million by the year 2040, and the number of patients who survive at least 5 years after initial diagnosis is expected to increase by 35% over the next decade. Improvements in cancer treatments for children and adolescents have led to modern 5-year survival rates of approximately 80% or greater. Despite the magnitude of the growing problem, the core issues related to cancer survivorship remain understudied and the research is often concentrated in highly prevalent cancers. Most studies are observational and descriptive with fewer studies focused on the prevention and treatment of complications. Cancer survivorship remains an area that is ripe for further discovery; a deeper understanding of the biological basis and/or the influence of genetics on host susceptibility and the long-term effects of cancer therapy is needed.

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