Conclusions

Quantitatively, cancer will directly affect one in three persons and 25 of all families including 20 of parents who will be cancer survivors caring for children. Cancer is now the major cause for death in patients less than 85 years of age. Qualitatively, the burden of cancer transcends all medical disciplines especially impacting the emotional well-being of many survivors. As a potentially fatal illness with a continued fear of relapse, the burden of cancer remains chronically active well...

Surgery 421 Cosmetic Effects

Most apparent but not always sufficiently addressed are the cosmetic effects of surgery. Patients may be embarrassed by their own distress from a seemingly minor problem with an otherwise good outcome and consequently may not bring forth their concerns. Nonetheless, visible scars from cancer surgery can result in some cases in social isolation. Other patients find the sight and smell of an ostomy to be repugnant and greatly overestimate how much it is apparent to others around them. It is...

The Extremities and Bone

Radiation can damage lymphatics and cause lymphedema independently of surgery. When combined with surgical lymph node dissection, however, the risk of lym-phedema is compounded. Radiation weakens bone. For example, painful sacral fractures are a late effect of pelvic radiation that can be concerning for local recurrence or osseous spread of a malignancy like rectal cancer. A history of radiation is associated with increased risk of spinal compression fractures within the field. Recently an...

Discussion

The results of the LAF survey presented in this chapter are consistent with those of similar surveys that demonstrated the broad-based burden of cancer survivorship, the many serious and long-term issues, and inadequate resources for assisting patients especially for non-medical needs.6,19 These studies also demonstrated the perseverance of the cancer patient to overcome those hardships with many survivors paradoxically experiencing that their life was actually improved by cancer. Learning how...

Systemic Effects

Although surgery is a local treatment, its effects can be systemic. For example, removal of endocrine and sexual glands in the course of cancer surgery can leave patients hypothyroid, diabetic, osteopenic, or menopausal. Removal of, or damage to, the sexual organs can render younger patients infertile, and so maneuvers such as sperm banking and embryo freezing must be anticipated and offered prior to surgery. Splenectomy may put patients at risk of overwhelming sepsis from encapsulated organs,...

Cranial Irradiation

Cranial irradiation can be the primary or adjuvant treatment for brain tumors, and may be carried out prophylactically, for example, in limited-stage small cell lung cancer and some hematological malignancies. While neurons do not have the rapid dividing characteristic usually targeted by radiation, radiation has effects on their glial supports and vasculature. Leukoencephalopathy typically occurs at doses above 55 Gy and appear 1-2 years following treatment.30 As a result, slowed mentation and...

Info

There is also consensus regarding a third set of findings from this literature on early effects of diagnosis and treatment with regard to the physical realm. These include menstrual changes and menopause, infertility, sleep problems, lymphedema, pain, problems with physical and recreational activities, and weight gain and reduced energy.15,18,30,32-40 Ganz found nearly identical rates of arm problems 2 and 3 years posttreatment related to the initial surgical procedure (numbness, tightness and...

Comparisons Of Longterm Effects Of Diagnosis And Treatment By Cancer Site Breast Cancer And Hodgkins Disease

In this section, we compare two studies conducted by the lead author and her colleagues. The first study was a longitudinal evaluation of physical, social, psychological, and spiritual QOL among long-term survivors of Hodgkin's disease. It was expected that type and frequency of the physical dimension of QOL would be explained by type of treatment, age at the time of treatment and time since diagnosis. It was also expected that social and psychological dimensions of QOL would be explained by...

Cognitive Effects

Chemo-brain is being increasingly recognized as a constellation of mild cognitive problems associated with prior exposure to multiagent chemotherapy. It has also been reported in men on testosterone suppression. The most common symptoms include problems with mentation, concentration, and memory. While several studies have shown this to be an actual phenomenon,49 the specific mechanisms are unknown. Moreover, it is not clear that chemotherapy itself causes these symptoms as detectable...

Ongoing Care Plan

The follow-up care plan should include communication about the likely course of recovery from acute treatment toxicities, as well as the need for ongoing health maintenance or adjuvant therapy. For example, any recommended chemopreven-tive strategies, such as tamoxifen for breast cancer or aspirin for colorectal cancer, should be reviewed at this time. It should also lay out the plan for surveillance for recurrence or development of new cancers. It should acknowledge the common late effects of...

Second Malignancies

Like radiation, chemotherapy is associated with second malignancies. The most common iatrogenic cancers attributable to systemic treatment are myelodysplasia and acute leukemia. These are usually associated with drugs that have alkylation as at least one of their mechanisms of action. Classic alkylators like cyclophosphamide contain an electorphilic alkyl group with an affinity for the N7 position on guanine. As a result, it intercolates itself between DNA strands causing mispairing of...

Miscellaneous Effects of Systemic Treatment

A series of other long-term and late effects are associated with specific systemic cancer drugs. For example, bleomycin causes pulmonary fibrosis at doses above 450 mg m2, especially in the elderly and those on supplemental oxygen,66 and the acrolein metabolite of cyclophosphamide and ifosfamide causes a hemorrhagic cystitis that in a small proportion of unfortunate patients can become chronic after a severe acute episode. Cisplatin can affect renal function, which can be either acute or of...

Cardiovascular Complications

Cardiac late effects are most closely associated with the anthracycline class of chemotherapeutic agents (doxorubicin, mitoxantrone, epirubicin). One of the mechanisms by which these drugs work is the creation of free radicals which damage the DNA of replicating cancer cells. However, free radicals also damage normal tissue. Cardiac muscle is particularly vulnerable because it lacks sufficient glutathione, which neutralizes free radicals. As a result, cardiac muscle accumulates progressive...

Directions For Future Research

Since 1998 when a rigorous review of the published research on long-term survivors was published, a rapid accumulation of research has occurred. In the United States this trend has accelerated since 1997, when the Office of Cancer Survivorship was created in the National Cancer Institute. This event provided greater visibility of the concerns of long-term survivors and funding set asides encourage research in this area. Our review of recent literature on long-term cancer survivors brought home...

Guidelines for Survivorship Care

Ideally, the survivorship care plan would be organized around a set of widely agreed-upon clinical practice guidelines. Guidelines are best when they are based on evidence and derived in a formal process of either evidence evaluation and or consensus. Unfortunately, there are few guidelines available for the management of cancer survivors. This situation reflects a lack of high-quality evidence in most cases, particularly for survivors of less-common cancers. In addition, experts widely...

Psychosocial Concerns

The majority of the evidence suggests that cancer survivors have good emotional functioning after cancer,68 although rates of some diagnoses, such as depression, are higher among cancer survivors than in the general population.69,70 Fear of recurrence and death understandably dominate adjustment disorders, and may reach the extent where they interfere with vocational and personal pursuits.71 Cancer survivors with preexisting anxiety or affective disorders appear to be at greatest risk for...

QOL in Long Term Survivors of Breast Cancer

In total, 16 studies met our search criteria for breast cancer, all published after 1998. The studies are described in Table 1 and include our study,32 which will be discussed in greater detail following the general review. Quality of life was a primary outcome in all studies. Of the 16, five studies compared the QOL between breast cancer survivors and healthy or normal controls.4,41-44 Two of five also compared QOL outcomes between survivors who have experienced a cancer...

Michael Feuerstein

As is now well known, the numbers of cancer survivors has increased considerably over the past decade and with aging trends in the population there is every reason to assume that this number will increase. Conditional survival rates, which provide a more dynamic prediction of survival for patients who have gone through initial treatment and continue to live several years post-diagnosis,1,2 indicate higher votes of survival than convential data. This is great news for those afflicted with the...

The Quantitative Burden Based On Cancer Statistics

Understanding the burden of cancer survivorship also requires a quantitative appreciation of the incidence of cancer, the mortality of the disease, and the resulting number of accumulating survivors. The American Cancer Society publishes an annual summary of cancer statistics.14 Based on data from the National Cancer Institute and mortality data from the National Center for Health Statistics, it is estimated that in the United States for 2005, a total of 1,372,910 new cancer cases and 570,280...

Early Effects Of The Diagnosis And Initial Treatment On

Although not included in our review, most studies of cancer survivorship and QOL focus on the immediate post-diagnostic and posttreatment periods. Some of the earliest systematic work on breast cancer was conducted by Morris and her colleagues26 and by Maguire and his colleagues,27 on Hodgkin's disease by Fobair et al.,28 and on prostate cancer by Litwin et al.29 Early work on emotions is exemplified by the Psychological Aspects of Breast Cancer Study (PABC).19 Almost three decades ago,...

The Qualitative Burden Of Cancer Survivorship From The Patients Perspective

To better understand the magnitude of the qualitative burden of cancer from the patient's perspective, the LAF conducted an open invitation Internet-based survey posted on the LAF Web site (http www.laf.org). The survey was a large-scale battery of 83 queries about pathological and psychosocial topics such as medical support, emotional support, patient attitude, secondary health problems, financial issues, social relations, employment problems, and concerns about activities of daily living....

Real Time Symptom Monitoring With Cancer Survivors

The use of computer adaptive tests with cancer survivors would minimize burden and help focus assessment. It has potential to sharpen measurement precision with a minimum number of questions255 and has several unique advantages 1 compared to paper-and-pencil tests, computer adaptive testing technology is efficient, requiring fewer questions to arrive at an accurate estimate 2 it allows respondents and providers to receive immediate feedback on the person's HRQL status 3 with its IRT...

Contributors

Ahles, PhD Director of the Neurocognitive Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, NY Carlynn A. Alt, PhD, PT, MS Assistant Professor, Exercise Science Program, Department of Physical Therapy Marquette University, Miluankee, WI Jane Alavi, MD Professor Emeritus, Department of Medicine, University of Pennsylvania Department of Medicine, Philadelphia, PA Tammy Beran, MA Graduate Student, Department of Psychology, University of California, Los Angeles, Los...