One of the most incredible success stories of modern medicine is that a cancer diagnosis is no longer a death sentence. For many, cancer is a survivable illness. Whereas few people survived cancer 40 years ago, 59%-65% of adults and 70%-92% of children will survive beyond five years after a cancer diagnosis today1,2. An estimated 3.3% of Americans are cancer survivors2.
Despite these encouraging statistics, progress in survival has come at a cost. Being cancer-free does not mean being free from the effects of the illness and its treatment. In fact, many survivors encounter long-term changes in their health status that are absent immediately after cancer treatment but manifest later when they are considered "cured" from cancer3,4. Recent research suggests that approximately 62% of cancer survivors have had at least one chronic health problem, 28% a severe condition, and 24% have three or more chronic health problems5.
One of the most devastating late effects cancer survivors face is the development of a new cancer arising as a result of the mutagenic effects of treatment, genetic predisposition, or aging. Second cancers are concerning because they predispose survivors to morbidity and early mortality through their effect on general health, quality of life, and long-term survival6.
At least 750,000 Americans (almost 8%) have been diagnosed with more than one form of cancer, and it is expected that at least one in nine people will develop two cancers in his or her lifetime7. Survivors of childhood cancer are 3 to 11 times more likely to develop cancer compared to the general population8,9. Estimates suggest that, following cancer in adulthood, survivors have a two-fold risk of developing cancer10,11. Common second cancers include leukemia and solid tumors, particularly cancers of the breast and thyroid. An emerging risk for childhood cancer survivors is the development of cancers of adulthood, including cancers of the genitourinary system, head and neck area, and gastrointestinal tract12. Most concerning is that second cancers may appear at any time during cancer survivorship and develop at a much younger age than in the general population4,13.
The implication of this increased risk for second cancers is the need for comprehensive cancer care that extends from the cancer diagnosis until death14. Once long-term survival has been achieved, vigilant care must continue in the form of secondary prevention interventions6. In the general population, secondary prevention interventions, including life-long surveillance, cancer screening, and health education, are recommended for the early detection of cancers and timely introduction of treatments to prevent or control cancers before signs and symptoms are apparent15. For cancer survivors, this proactive approach to cancer control translates into maintenance of cancer-free survival and prevention of cancer-related morbidity14.
References:
1. Davies, S.M. (2007). Subsequent malignant neoplasms in survivors of childhood cancer: Childhood Cancer Survivor Study (CCS) studies. Pediatric Blood and Cancer, 48(7), 727-730.
2. Ries, L.A.G., Harkins, D., Krapcho, M., Mariotto, A., Miller, B.A., Feuer, E.J., et al. (2006). SEER cancer statistics review, 1975-2003. Bethesda, MD: National Cancer Institute.
3. Oeffinger, K.C., & Hudson, M.M. (2004). Long-term complications following childhood and adolescent cancer: Foundations for providing risk-based health care for survivors. CA: A Cancer Journal for Clinicians, 54(4), 208-236.
4. Tichelli, A., & Socie, G. (2005). Considerations for adult cancer survivors. Hematology, 1, 516-522.
5. Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Kawashima, T., Hudson, M.M., Meadows, A.T., et al. (2006). Chronic health conditions in adult survivors of childhood cancer. New England Journal of Medicine, 355(15), 1572-1582.
6. Hudson, M.M. (2005). A model for care across the cancer continuum. Cancer, 104(Suppl.), 2638-2642.
7. Mariotto, A.B., Rowland, J.H., Ries, L.A., Scoppa, S., & Feuer, E.J. (2007). Multiple cancer prevalence: A growing challenge in long-term survivorship. Cancer Epidemiology, Biomarkers, and Prevention, 16(3), 566-571.
8. Cardous-Ubbink, M.C., Heinen, R.C., Bakker, P.J., van den Berg, H., Oldenburger, F., Caron, H.N., et al. (2007). Risk of second malignancies in long-term survivors of childhood cancer. European Journal of Cancer, 43(2,) 351-362.
9. Inskip, P.D., & Curtis, R.E. (2007). New malignancies following childhood cancer in the United States, 1973-2002. International Journal of Cancer, 121(10), 2233-2240.
10. Mahon, S.M. (2005). Tertiary prevention: Implications for improving the quality of life of long-term survivors of cancer. Seminars in Oncology Nursing, 21(4), 260-270.
11. Somerville, H.M. (2003). Second malignant neoplasms following treatment for primary cancer. Australian Family Physician, 32(1-2), 25-31.
12. Bassal, M., Mertens, A.C., Taylor, L., Neglia, J.P., Greffe, B.S., Hammond, S., et al. (2006). Risk of selected subsequent carcinomas in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 24(3), 476-483.
13. Bhatia, S., Blatt, J., & Meadows, A.T. (2006). Late effects of childhood cancer and its treatment. In P.A. Pizzo & D.G. Poplack (Eds.), Principles and practice of pediatric oncology (5th ed.). Philadelphia: Lippincott Williams and Wilkins.
14. Pollack, L.A., Greer, G.E., Rowland, J.H., Miller, A., Doneski, D., Coughlin, S.S., et al. (2005). Cancer survivorship: A new challenge in comprehensive cancer control. Cancer Causes Control, 16(Suppl. 1), 51-59.
15. Champion, V.L., & Rawl, S.M. (2005). Secondary prevention of cancer. Seminars in Oncology Nursing, 21(4), 252-259.
