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The population of cancer survivors, which numbered over 11 million in 2006 (1), continues to grow as "baby boomers" reach a cancer-prone age (increasing the annual incidence of new cases) and as cancer patients survive longer (increasing the prevalence of cancer survivors).

According to the National Institute of Health's Surveillance, Epidemiology, and End Results (SEER) Cancer Statistics 1975-2006, there has been an increase in 5-year relative survival rates; in 1954 the 5-year survival rate for all cancer sites was 35%, but by 2005 this figure had increased to 69.1% (2). Obviously survival rates are dependent on cancer site and the 5-year relative survival rate is not correlated with cancer incidence as illustrated in Table 50-1.

Table 50–1. Incidence and 5-Year Survival Rate by Specific Cancer Site

Late Effects of Cancer

There has been a gradual appreciation that the life trajectory of individuals diagnosed and treated for cancer can extend far beyond the often limited duration of active therapy. Indeed, both the national Coalition for Cancer Survivorship (NCCS) established in 1986 and the Office of Cancer Survivorship (OCS) established in 1995 have served to highlight the importance of life after cancer treatment. For many malignancies, cancer is now considered a chronic condition with prolonged life expectancy occasionally punctuated by intervals of disease reactivation requiring treatment but also with need to monitor lifelong for the detection and management of potential cancer-related late effects.

Efforts are increasingly directed toward understanding the long-term impact of cancer and cancer therapy, especially as they might affect the quality of life of cancer survivors. There is a robust collection of literature addressing the psychosocial late effects of cancer in survivors of childhood and adult cancers. However, information regarding the lasting medical late effects of cancer and cancer therapy remains limited.

Several investigators have addressed the presence and complexity of lasting medical effects of cancer throughout the adult lives of childhood cancer survivors (3-5). Stevens et al. (6) reported that 58% of survivors had at least one chronic health problem and 32% had two or more, including second primary cancers. Much less is known about the lasting medical impact of cancer treatment in survivors of adult-onset cancers. Investigators addressing the physiologic late effects of ...

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