Cancer survivorship

Advances in cancer screening, early detection, improvements in therapeutics, and supportive care or contribute to decreasing cancer mortality.

There will be an estimated 26 million survivors in 2040, the majority of whom will be in their 60s,70s, or 80s.

Approximately two-thirds of survivors are aged 65 years or greater in estimated one and every five persons age greater than 65 years is a cancer survivor.

Approximately 53% of survivors were diagnosed within the last 10 years, whereas approximately 18% have survived 20 years or more.

There were more than 18 million cancer survivors in the US in 2022.

There are approximately 500,000 adult survivors of childhood malignancies.

Only 5% of cancer survivors are less than 40 years of age, and survivors of childhood cancer counts to between 0.5 and 3% of the survivor population.
Most common cancers in the survival population are: breast, prostate, colon/rectum, and melanoma accounting for 58% of survivors.

Approximately 64% of survivors had a diagnosis of five or more years ago, and 15% of survivors were diagnosed 20 or more years ago, and approximately 5% have survived 30 years or longer.

Some survivors have more than two unrelated primary cancers in their lifetime.

The overall incidence of subsequent primary cancers in survivors is higher than the incidence of cancer in the general population because of genetic susceptibilities, and shared causative factors, and/or the mutagenic affects of cancer treatment.

A range of 6-16% of cancer survivors harbor a germline mutation in a  gene associated with oncogenesis.

More than half of cancer survivors are affected by obesity, consume two or less servings of fruits and vegetables and/or exercise two times or less each week: only 7.6% of all survivor is met all six behavioral recommendations regarding physical activity, use of sunscreen, tobacco avoidance, minimizing alcohol, weight management, and medical follow up.

Treatment related subsequent primary cancers vary with the type in intensity of anticancer therapies and their associated particularly with radiation and specific chemotherapeutic agents.

Cancer survivors are at risk for loss of fertility going to treatment with chemotherapy, radiation, therapy, or both.

There is an increased risk of developing obstetric and birth complications for female cancer survivors, in terms of increased risk of prematurity, low birthweight, emergency cesarean section, assisted vaginal delivery, and postpartum hemorrhage.

Patients with bladder cancers have the highest risk for subsequent primary cancers – 34% at 20 years.

Approximately 8% of survivors of cancers diagnosed after age 18 develop a subsequent malignancy with a mean followup of seven years, with 55% of the survivors dying as a result of the subsequent cancer.

Survivorship starts at the time of diagnosis and lasts throughout the lifespan.

The care of survivors is an integral part of the cancer care continuum.

Poor sleep, fatigue, and cognitive difficulties are common concerns in the cancer survivorship population.

Cognitive concerns with learning, memory, concentration, processing speed, executive function or reported by approximately 46% of cancer survivors.

The prevalence of cognitive impairment in cancer survivors varies by the type of cancer: greater than 80% of survivors of CNS tumors, around half of survivors with breast cancer, lymphoma, colorectal cancer, or head and neck, cancer, 30% with testicular cancer, and less than 20% for prostate cancer.

Younger age, females being separated, divorced, or widowed, working part time or unemployed, and those with a lower household income have increased likelihood of survival perceived cognitive dysfunction.

Individuals treated with chemotherapy are five fold more likely to report cognitive difficulties in those patients treated with surgery or radiation.

Premature aging results in childhood cancer survivors resulting in a frailty phenotype.

The evidence that surveillance for metastases reduces mortality or improves health related quality of life is limited.

Randomized trials do not support surveillance for metastatic disease in asymptomatic female survivors of breast cancer.

Overall survival is unchanged between the asymptomatic screen population and women who undergo surveillance testing when they are symptomatic.

In colon cancer surveillance improve the likelihood of finding respectable hepatic metastasis and with liver resection and systemic chemotherapy it may result in long-term survival in some cases.

All persons with potentially curable cancers should have recommended sex and age specific routine screening tests, and care recommended for the general population, that includes: colonoscopy, mammography, Pap smears and human papillomavirus testing, bone densities, vaccinations, and screening for hypertension, lipid abnormalities, and diabetes.

Screening recommendations for a new primary cancers and cancer survivors may differ from the screening recommendations for a healthy person with no history of cancer.

Long term treatment effects are side effects that begin during an extended beyond treatment, whereas the late effects occur after treatment ends.

Late and long term effects vary according to treatment exposures in individual host factors.

Cardiovascular disease is a leading cause of death and the most common cause of non-cancer death for survivors of most cancer types.
Increased cardiovascular risk in cancer survivors:cytotoxic, hormonal, targeted therapies search is HER2  directed therapy, VEGF Inhibitors, cis-platinum, anthracyclines, androgen deprivation therapy, and radiation therapy.
Shared risk factors for both cancer in cardiovascular disease contribute to the development of cardiovascular disease and cancer survivors and includes: tobacco use, obesity, and poor health behaviors.

Cancer survivors have a markedly increased risk of developing cardiovascular disease compared with non-cancer populations.

Radiation causes late effects with long latency, primarily radiation-induced second cancers and cardiovascular disease.

cardiovascular risk factors such as hypertension, hyperlipidemia, and diabetes are more common in cancer than non-cancer populations, and most cardiovascular diseases develop overtime as a result of these other risk factors.

The risk of cardiovascular related death in most survivors begins at greatest risk of five years or more after diagnosis and completion of curative therapy.

Chemotherapy may cause premature or accelerated aging in survivors of cancer in adulthood and survivors of cancer in childhood.

Compared with the general population adult cancer survivors have a 14% higher risk of developing a new malignant disease for a variety of reasons which include: genetic predisposition, the use of carcinogenic cancer treatments, and environmental and lifestyle related risk factors.

Chemotherapy related biological side effects include telomere shortening, decreases in maximal oxygen consumption, and increased levels of inflammatory cytokines.

Hormone deficiencies related to treatments may contribute to senescence.

Chemotherapy can cause primary hypergonadism in premenopausal women, and long-term treatment with anti-androgens, gonadotropin hormone releasing agonists and anti-estrogen suppressor circulating androgen estrogen levels.

Premature aging is most evident in childhood cancer survivors, the majority of whom have coexisting medical conditions, which may be life-threatening, by the age of 45.

Adverse body composition changes that occur with cancer are associated with poor survival outcomes.

Rates of cardiovascular events are increase with the anthracycline therapy and radiation therapy.

In patients treated with chemotherapy, particularly testicle cancer survivors, the experience up to a 7 fold increase long risk of cardiovascular disease compared with controls.

Sarcopenia occurs in some cancer survivors treated with chemotherapy.

The principles of weight management, increased physical activity, healthy diet, smoking cessation, and reduced alcohol consumption are the foundations for improved health and wellness for everyone, and especially for cancer survivors.

Cancer survivors are more likely to be former drinkers and less likely to be current drinkers when compared with individuals without a history of cancer.

Obesity is a risk factor for the development of common cancers such is breast cancer, colon cancer, and prostate cancer, and it also increases mortality among breast cancer survivors and it may increase mortality among prostate or colon cancer survivors as well.

Physical activity improve quality of life in cancer survivors, and it may decrease mortality among survivors of some cancers.

There is evidence that physical activity association with cancer survival is improved and is stronger post diagnosis than pre-diagnosis.

One third of cancer survivors have little or no participation in leisure time physical activity while spending prolonged time sitting.

Cancer related fatigue is one of the most pervasive toxicities experienced by survivors.
Up to 40% of survivors continue experiencing debilitating fatigue after completion of treatment.

There is a significant inverse association between exercise and all-cause mortality in adult survivors of childhood cancer.

Tobacco cessation is an essential component of care for survivors.

Continued alcohol consumption increases cause specific mortality among survivors with various cancers.

Chemotherapy causes premature or accelerated aging in both survivors of cancer in adulthood and survivors of cancer in childhood.

Chemotherapy related side effects include telomere shortening, decreases in maximal oxygen consumption, and increased levels of inflammatory cytokines.

Chemotherapy causes hypogonadism in premenopausal women, and long-term treatment with anti-androgens, gonadotropin hormone releasing agonists and anti-estrogen suppress is circulating androgen and estrogen levels.

Premature aging is most evident in survivors of childhood cancers, and the majority of whom have coexisting medical conditions, which may be life-threatening by the age of 45 years.

Premature development of comorbidities observed in aging is also seeing the young cancer survivors, including one that spans multiple decades.

The premature development of comorbidities normally associated with aging has been observed in various studies of young cancer survivors, including one that spans multiple decades.

Compared with siblings, childhood survivors of cancer have more than three times the risk for any chronic condition and more than eight times the risk for serious or life-threatening condition.

Updated results showed a significant reduction in the cumulative incidence of at least one grade 3 to grade 5 chronic conditions among childhood survivors diagnosed in previous decades compared to more recent years.

Among adults cancer survivors several types of primary cancer are significantly associated with a greater risk of developing and dying from a second primary cancer compared with the general population: cancers associated with smoking or obesity comprised a substantial proportion of second primary cancer incidence and mortality among survivors.

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