Y e a r s l i v e d w i t h d i s a b i l i t y d u e t o c a n c e r , 2 0 1 7

4 9 , 9 9 4 o r f e w e r4 9 , 9 9 5 - 1 9 2 , 0 9 51 9 2 , 0 9 6 - 4 8 3 , 7 0 54 8 3 , 7 0 6 - 9 8 9 , 9 2 19 8 9 , 9 2 2 o r m o r eN o d a t a

P r o p o r t i o n p e r 1 0 0 , 0 0 0

2 5 6 o r l e s s2 5 7 - 4 3 94 4 0 - 6 6 26 6 3 - 1 , 0 1 11 , 0 1 2 o r m o r eN o d a t a

Figure 1Prevalence of poor health-related quality of life among cancer survivors and adults without cancer, US,2010

Poor physical health Poor mental health Poor physical and mental health

canceratlas.cancer.org

0

10

20

30

Adults without cancerCancer survivors

canceratlas.cancer.org

25 THE BURDEN

The number of cancer survivors is rising world-wide, propelled by advances in early detection and treatment and the aging of the world’s population. In 2018, there were approximately 43.8 million cancer survivors diagnosed within the previous 5 years. MAP 25.1

Their growing visibility makes it increasingly clear that while some cancer survivors thrive, for many, life after cancer presents lasting challenges. Fear of recurrence, depression, pain, memory

problems, sexual dysfunction, relationship issues and school worries are common. Late effects (occurring months or years after treatment ends) may include cardiac problems, lymphedema, impaired functional status, and second cancers. MAP 25.2 Combined, long-term and late effects of cancer may double survivors’ risk of poor mental and physical health-related quality of life. FIGURE 25.1

Working-age cancer survivors often face challenges in maintaining employment. They increasingly experience medical financial hardship, including problems paying medical bills, financial distress, and delaying or forgoing care because of cost. In the USA, as many as 60% of working-age cancer survivors report at least one type of financial hardship.

Among older adults, most of those diagnosed with cancer present with one or more co-morbid health conditions. As the proportion of survivors who are older increases, rates of cancer-related morbidity can be expected to rise as well. To reduce the human cost of cancer, finding ways to screen those at risk for and mitigating adverse effects of treatment will be increasingly important, as will tailored follow-up care.

National guidelines for coordinated survivor-ship care are in place in some high-income countries, such as Australia, Canada, and the UK. FIGURE 25.2 In the US, guidelines are not always consistent. Survivorship care guidelines are less common in low- and middle-income countries. Developing and delivering care that addresses the long-term and late occurring effects of cancer and its treatment represent key challenges of survivor-ship worldwide.

Compared with those who have not had cancer, cancer survivors are more likely

to experience poor physical and/or mental health.

Years lived with disability due to cancer

are highest in the countries with both high

cancer rates and large populations, like China,

the US, and Russia.

Cancer survivors tend to be concentrated in

higher-income countries where screening,

diagnosis, and effective treatment are more

accessible.

CANCER SURVIVORSHIPThe growing population of cancer survivors represents a global challenge for survivors and their families, employers, healthcare systems and governments.

FIGURE 25.1

FIGURE 25.2

Prevalence (%) of poor health-related quality of life among cancer survivors and adults without cancer, US, 2010

Suggested site-specific surveillance recommendations for cancer survivors, United Kingdom

canceratlas.cancer.org

1,012 or more

989,922 or more

No data

No data

663–1,011

483,706–989,921

440–662

192,096–483,705

256 or less

49,994 or fewer

257–439

49,995–192,095

MAP 25.1

MAP 25.2

Estimated number of cancer survivors diagnosed within the past five years per 100,000 population, both sexes, 2018

Years lived with disability due to cancer, both sexes, all ages, 2017

Guidelines for follow-up care exist in some high-income countries, but are uncommon in low- and

middle-income countries.

The challenge in overcoming cancer is not only to find therapies that will prevent or arrest the

disease quickly but also to map the middle ground of survivorship and minimize its medical and

social hazards.

— Fitzhugh Mullan, founding member, National Coalition for Cancer Survivorship

“

BREAST CANCER (EARLY AND LOCAL STAGES)People who have had treatment for breast cancer should have an agreed, written care plan, which should be recorded by a named healthcare professional.

Offer annual mammography to all people with breast cancer for 5 years.

Offer patients regular surveillance with a minimum of two CTs of the chest, abdomen, and pelvis in the first 3 years and regular serum carcinoembryonic antigen tests (at least every 6 months in the first 3 years).

Offer a surveillance colonoscopy at 1 year after initial treatment. If this investigation is normal consider further colonoscopic follow‑ up after 5 years.

Offer all patients an initial specialist follow‑up appointment within 6 weeks of completing treatment to discuss ongoing care. Offer regular appointments thereafter, rather than relying on patients requesting appointments when they experience symptoms.

Offer protocol‑driven follow‑up led by a lung cancer clinical nurse specialist as an option for patients with a life expectancy of more than 3 months.

LUNG CANCER

COLORECTAL CANCER

Many cancer survivors face late

and lasting medical, emotional, and social

challenges resulting in 7.8 million years

lived with disability globally in 2017.

copyright © 2019 the american cancer society, inc.