More cancer survivor planning urged
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* Nancy Benac

The number of cancer survivors in the United States has reached nearly 12 million, according to a new government report that tells a remarkable success story and at the same time, underscores the pressing need to provide people with more tailored physical and psychosocial care in the years after they complete cancer treatment.

The US Centers for Disease Control and Prevention and the National Cancer Institute said the new estimate of 11.7 million cancer survivors in 2007, the latest year for which figures are available, represents about 4% of the population. It is up from 3 million in 1971, or about 1.5% of the population.

Some highlights from the report, *Cancer Survivors in the United States, 2007* ([www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm?s\_cid=mm6009a1_w](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6009a1.htm?s_cid=mm6009a1_w)):

*   Women who had breast cancer were the largest group of survivors, at 22%; followed by men with prostate cancer, 19%; and colorectal cancer survivors, 10%.

*   Nearly 60% of cancer survivors were 65 or older; 35% were 40–64; 5% were 20–39; and less than 1% were 19 or younger.

*   About 65% had lived with a cancer diagnosis for at least five years; about 40% had been diagnosed at least 10 years earlier; nearly 10% had been diagnosed for more than 25 years.

*   Women accounted for 54% of cancer survivors.

Julia Rowland, director of the cancer institute’s Office of Cancer Survivorship, says the report demonstrates the need for better research on how to develop and deliver “survivorship care plans” that give patients detailed information about what kind of cancer they had, what treatment they received, and a tailored plan for follow-up treatment.

Many people don’t even remember what drugs or therapies they were exposed to, and don’t know what special risks they may face, Rowland says.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/8/E468/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/183/8/E468/F1)

There were an estimated 11.7 million cancer survivors in the United States in 2007, according to US government agencies.

Image courtesy of © 2011 Thinkstock

Cancer survivors can face all sorts of unique medical considerations: some are at increased risk for second malignancies and may need to be screened on different schedules. Cancer treatment may cause serious side effects such as infertility and nerve damage, or exacerbate underlying conditions in patients. The disease also can leave survivors with depression, fatigue and emotional issues to sort out.

For many cancer survivors, the period after treatment can be a “teachable moment” when they are open to changes in diet, exercise and screening, Rowland says. “What we are hearing from the survivor population is they want guidance on what is appropriate follow-up care.”

Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, says the report represents “a success story that comes with some cautions.”

He says that while better treatment options are one reason for the growing numbers of cancer survivors, another is that sophisticated detection methods are turning up some cancers that never would have caused a problem for patients.

“They have a disease that would have escaped detection in the past, and they would have gone about their lives without that diagnosis,” he says.

Lichtenfeld said more research is needed to better define how aggressive or indolent a person’s cancer may be.

At the same time that “overdiagnosis” is pushing the number of cancer survivors up, Lichtenfeld says, there are many other people who are avoiding the survivor label because of successful screening programs that are helping them avoid developing cancer in the first place.

Lichtenfeld says medical professionals have an obligation to pay more attention to “follow-on issues” for cancer survivors, ranging from the long-term medical consequences of intensive cancer treatment to financial and insurance issues. He cites cases of patients whose radiation treatment placed them at higher risk of breast cancer, cardiac problems and hip difficulties. In addition, he says, new risks may be identified in future years.

For now, Lichtenfeld says, cancer patients need to get information from their oncology team about their diagnosis and treatment and keep it in a safe place. “They can’t rely on the health system,” he says. “This will change when patients demand care summaries. … That will accelerate the transformation.”

The report defined a cancer survivor as anyone who had been diagnosed with cancer and was still alive. It did not specify whether a survivor had been cured, was in active therapy, was living with a chronic cancer-related illness or disability or was dying from cancer. It did not include people with nonmelanoma skin cancers, which are fairly common and rarely fatal.