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NCI Spotlights
Survivorship
What quality of life can long term cancer survivors expect? This
question was the focus of a two-day conference sponsored by the NCI Office of
Cancer Survivorship March 9-10, 1998 in Bethesda MD.
“Prolonged survival and cure after a cancer diagnosis has
been one of the remarkable achievements of late twentieth century
medicine,” said Patricia Ganz MD of the Jonsson Comprehensive Cancer
Center, UCLA Schools of Medicine and Health. “However the price of
prolonged survival sometimes includes acute organ toxicities (e.g., radiation
pneumonitis, acute renal failure, or sepsis), chronic toxicities (e.g.,
pulmonary fibrosis, congestive heart failure, graft-versus-host disease,
neurological syndromes, infertility, or hypothyroidism) or serious risk of
second malignancies.” Further research is needed to identify individuals
at risk for these late effects, said Ganz.
“We must move away from a ‘take no prisoners’
theory of cancer care and begin considering the sequelae of the treatment we
are giving patients,” said Richard Klausner MD, Director of the National
Cancer Institute. “We have to overhaul our programs so that we can follow
survivors, ask the questions and get the answers we need to evaluate the
effects of cancer treatment on long-term health.”
Secondary cancers—cancers diagnosed in patients previously
treated for cancer at a different site—are on the rise, reported Frederick
Li MD of the Dana Farber Cancer Institute. He estimates that secondary cancers
are the fourth or fifth most commonly diagnosed type of cancer in the U.S.
today. “It’s inevitable that secondary cancers will become the
leading cancer among Americans as we become more successful in treating primary
cancers,” said Li.
Secondary cancers result from several factors: a genetic
predisposition to developing cancer at more than one site, continued exposure
to carcinogens such as tobacco that can produce cancers at more than one site,
and prior exposure to certain chemotherapy drugs and/or radiation. We need to
identify and avoid risk factors for second cancers, stressed Li, so that we can
improve both the duration and qualify of survival of cancer patients.
Steven Lipshultz MD, Professor and Chief of the Division of
Pediatric Cardiology at the University of Rochester Medical Center, warned that
some childhood cancer survivors whose treatment included cardiac radiation or a
class of chemotherapy drugs called anthracyclines (daunoxorubicin, doxorubicin
and epirubicin) are becoming one of the largest new groups at risk for
cardiovascular disease. He noted that 15 percent of patients enrolled in the
Pediatric Cardiomyopathy Registry had a previous cancer diagnosis.
A large-scale study is underway to determine the extent of
cognitive problems experienced by patients treated for lymphoma and breast
cancer, reported Tim Ahles Ph.D. of the Dartmouth-Hitchcock Medical Center in
New Hampshire. Cognitive problems such as memory loss, an inability to
concentrate and difficulty reasoning have been a complaint of many bone marrow
and stem cell transplant survivors. A recent study by the Netherlands Cancer
Center found that 34 percent of women treated with high-dose chemotherapy for
breast cancer had cognitive abnormalities after treatment, as compared to 17
percent of women treated with low-dose chemotherapy and nine percent who had
received no chemotherapy.
Ahles said the current U.S. study will ask 700 to 800 lymphoma and
breast cancer survivors whether they’ve developed cognitive problems since
treatment. A smaller subset will undergo neuropsychological testing and MRI to
measure the extent of the problem. If the study confirms that some cancer
survivors are experiencing cognitive difficulties after treatment, the next
steps will be to identify the specific drugs that cause the problems, predict
which patients are most likely to have long-term problems and develop
rehabilitation techniques to help them cope, said Ahles.
The NCI has allocated $15 million for multi-year research into
these and other cancer survivorship issues. |
