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Cancer Survivorship: Meeting the Challenge in Delivery of Quality Cancer Care Patricia A. Ganz, M.D. Jonsson Comprehensive Cancer Center UCLA Schools of Medicine & Public Health Marshfield Clinic Grand Rounds June 10, 2011

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Disclosure Statement I, Patricia Ganz, M.D., do not have any relevant financial interest or other relationships with a commercial entity producing health-care related product and or services.

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Cancer Survivorship: Meeting the Challenge in Delivery of Quality Cancer Care CME Activity Objectives Define the epidemiology of cancer survivorship Recognize the rationale for the use of survivorship care plans List the three P's of survivor care

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Who are the Cancer Survivors? More than 1 in 3 Americans will be diagnosed with cancer in their lifetime 12 million Americans have a personal history of cancer; nearly 4% of US population More than 25 million people are survivors world wide The number of cancer survivors will increase sharply during the next 25 yrs with aging of the population

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American Cancer Society Public Service Advertisement ca. 1988

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Cancer Survivor Facts 60% of survivors are currently over the age 65 years. Breast, Prostate, and Colorectal, are the 3 most prevalent cancer sites. Approximately 14% of the 12 million estimated cancer survivors were diagnosed over 20 years ago. The current average age of male and female cancer survivors is 69 and 64 respectively.

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5-Year Survival of Patients with Cancer by Era, SEER, 1975-1998 Age at Diagnosis (Years) 40 50 60 70 80 010203040506070 Year of Diagnosis 1993-98 1987-92 1981-86 1975-80 Survival (%) 2004 Projected Peak to Valley Transformation

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Five-year Relative Survival (%)* during Three Time Periods By Cancer Site *5-year relative survival rates based on follow up of patients through 2003. Recent changes in classification of ovarian cancer have affected 1996-2002 survival rates. Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006. Site1975-1977 1984-1986 1996-2002 All sites505366 Breast (female) Breast (female)757989 Colon 515965 Leukemia354249 Lung and bronchus131316 Melanoma828692 Non-Hodgkin lymphoma485363 Ovary3740 45 Pancreas23 5 Prostate6976100 Rectum495766 Urinary bladder737882

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Survivors by Cancer Invasive /1st Primary Cases Only (N = 11.1 million) SEER Nov 2007

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How did we make such incredible strides? Earlier detection New drugs and other treatments Combined modality therapy Prolonged adjuvant and/or maintenance therapies High dose chemotherapy with HCT Prevention of second malignancies

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But there is a cost Time Money Human Interpersonal Existential

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For many individuals, cancer is now a chronic disease..

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Comparison of cancer survivors and age- matched individuals from the National Health Interview Survey (NHIS) in 2000 Multiple measures of burden embedded within the survey JNCI 96:1322, 2004

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Health Status is Significantly Poorer in Cancer Survivors Yabroff, JNCI 2004 Cancer Survivors (N=1817) Noncancer Controls ( N=5465) P