June 15, 2012 — The number of people living after cancer is steadily increasing. There are currently an estimated 13.7 million cancer survivors in the United States; it is predicted that this will reach 18 million by 2022, according to the first-ever report on this subject from the American Cancer Society (ACS), in collaboration with the National Cancer Institute (NCI).
Even though the incidence rates of many cancers are decreasing, "the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates," the report notes.
It is increasingly important to understand the unique medical and psychosocial needs of survivors.
"As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors, and be aware of resources that can assist patients, caregivers, and healthcare providers in navigating the various phases of cancer survivorship," the authors note.
Rebecca Siegel, MPH, and colleagues from the ACS used data from the NCI-funded Surveillance, Epidemiology and End Results (SEER) database for their report and for a related paper published online June 14 in CA: A Cancer Journal for Clinicians.
It is vital that healthcare providers are aware of the special needs of cancer patients.
"Many survivors, even among those who are cancer free, must cope with the long-term effects of treatment, as well as psychological concerns such as fear of recurrence," said Elizabeth Ward, PhD, senior author on the report and national vice president of intramural research at the ACS.
"As more people survive cancer, it is vital that healthcare providers are aware of the special needs of cancer patients and caregivers," she said in a statement.
Need to Improve Follow-up
"Regular medical care following primary treatment is particularly important for cancer survivors because of the potential persistent and delayed effects of treatment, as well as the risk of recurrence and additional primary malignancies," the authors write.
The Institute of Medicine Committee on Cancer Survivorship outlined recommendations for coordinating the care of survivors. Included is a recommendation that the oncology team prepare a treatment summary, outlining the diagnosis and treatment received, which can then be referred to by both patients and their primary care providers.
However, many survivors do not receive this information, the authors note. A recent study found that less than half of NCI-designated cancer centers provide survivorship care plans for their colorectal and breast cancer patients.
The ACS report highlights the need to better coordinate the transition from oncology care to primary care. It also outlines the need to emphasize health behaviors that reduce cancer risk, such as avoiding smoking and sun exposure, exercising, and maintaining a healthy body weight, adding that these "are particularly relevant for survivors."
The authors highlight the existence of the National Cancer Survivorship Resource Center, which is a collaboration between the ACS and the George Washington Cancer Institute and is funded by the Centers for Disease Control and Prevention. The center has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, healthcare professionals, advocates, and policy makers, the authors note.
Survivor Characteristics
The authors analyzed the characteristics of the 13.7 million cancer survivors who were alive in the United States as of January 2012.
Nearly half (45%) of all cancer survivors are elderly (70 years and older); only 5% are younger than 40 years. The median age at diagnosis was 66 years old. The majority (64%) of cancer survivors were diagnosed at least 5 years previous, and 15% were diagnosed at least 20 years previous.
Men surviving cancer are most likely to have had prostate cancer (43%); women are most likely to have had breast cancer (41%).
Although surviving other types of cancer is less common, a wide range of cancers is represented among survivors.
For men, these cancers include colorectal (9%), melanoma (7%), urinary bladder (7%), non-Hodgkin's lymphoma (4%), testis (4%), kidney and renal pelvis (3%), lung and bronchus (3%), oral cavity and pharynx (3%), and leukemia (3%).
For women, the they include uterine (8%), colorectal (8%), melanoma (7%), thyroid (6%), non-Hodgkin's lymphoma (4%), cervical (3%), lung and bronchus (3%), ovary (3%), and urinary bladder (2%).
These proportions are not expected to change in the near future, the authors report.
Survivors of Childhood Cancers
The authors estimate that there are currently 58,510 survivors of childhood cancer living in the United States, and an additional 12,060 children will be diagnosed in 2012.
The most common cancers in children are leukemia (34%), brain and other nervous system malignancies (27%), neuroblastoma (7%), Wilms tumor (5%), non-Hodgkin's lymphoma (4%), Hodgkin lymphoma (4%), rhabdomyosarcoma (3%), retinoblastoma (3%), osteosarcoma (3%), and Ewing's sarcoma (1%).
These survivors of childhood cancer constitute a special case; they are at risk for treatment-related adverse effects for years after their cancer is gone. The authors note that valuable information on these late adverse effects has been provided by the ongoing Childhood Cancer Survivor Study, which continues to follow more than 14,000 long-term survivors.
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