Beating Cancer Brings New Battles
By Amanda Gardner
For some of the 10 million Americans who have survived cancer, life can be bittersweet. Their everyday concerns focus not just on whether the disease will recur, but also on psychological issues, fears about sexual impairment and financial worries.
"We're now dealing with some of the consequences of our 'success'," said Dr. David Johnson, outgoing president of the American Society of Clinical Oncologists (ASCO)and deputy director of the Vanderbilt-Ingram Cancer Center in Nashville. "We are very well equipped as physicians to deal with the physical needs of patients. We're less equipped for their psychological needs."
Johnson, who is a cancer survivor himself, recalled that when he had finished treatment for lymphoma, he asked his doctor what to do next. The doctor, a world-class oncologist, just shrugged.
"I didn't like that answer very much. I felt it was unacceptable," Johnson recalled. "I wanted an exercise program, a diet program. [As a doctor], I'm still not able to answer these questions. We have to pay some attention to the psychological needs of patients."
Several studies presented this week at the annual meeting of ASCO, held in Orlando, addressed some of the issues of survivorship.
One study found that adult survivors of childhood cancers treated in the 1970s and 1980s had a five times higher risk of experiencing moderate to severe health problems compared to their healthy siblings.
Experts have long known that people who have undergone radiation or chemotherapy for cancer can experience such problems as lung scarring, blood clots and eye and kidney problems.
The authors of this study looked at data on 10,397 long-term survivors of cancer diagnosed between 1970 and 1986 and compared it with similar information on 3,034 of their healthy siblings. The data had been collected as part of the Childhood Cancer Survivor Study (CCSS). Survivors ranged from 18 to 48 years old at the time of the study while healthy siblings ranged in age from 18 to 56.
By the time they were 45, just over 57 percent of the cancer survivors and a little more than 18 percent of the siblings reported moderate health problems. Examples of such health problems included lung scarring or ovarian or testicular failure.
By the same age, 37 percent of survivors and 4.6 percent of siblings reported severe health problems, such as having suffered a heart attack or paralysis.
"Sixty six percent of survivors will have some type of physical health condition by 30 years post-diagnosis," said Dr. Kevin C. Oeffinger, M.D., lead author of the study and professor of family medicine at the University of Texas Southwestern Medical Center, in Dallas.
The good news, Oeffinger added, is that some of these health conditions can be controlled with a doctor's help.
For the psychological impact of the disease, a survey conducted by the nonprofit Lance Armstrong Foundation found that most cancer survivors also suffer significant psychosocial effects such as depression, fear of a recurrence and impaired sexuality.
The survey involved 1,020 cancer survivors aged 18 to 75 who completed an online questionnaire in October 2004.
The majority (70 percent) of respondents said they had suffered depression as a result of their cancer; 53 percent felt that emotional issues were harder to handle than physical issues, and 49 percent said they had nonmedical cancer-related needs that were not being met, such as financial problems and sexual concerns.
In fact, 9 percent of the respondents said they had incurred debt of more than $25,000 as a result of their diagnosis, although lead author Dr. Steven N. Wolff said he felt a larger survey would indicate that more people were saddled with such debt.
In addition, 70 percent of those surveyed said they felt their doctors were ill equipped to help with these nonmedical issues.
"The consequences of cancer do not end when the cancer treatment ends," said Wolff, a professor of medicine at Meharry Medical College in Nashville, Tenn.
"The survey says that nonmedical issues are as prevalent as medical issues, which include psychological and financial issues currently not being addressed due to non-recognition or lack of available physician skills or resources," added Wolff, whose son is a childhood cancer survivor.
In December, ASCO announced that it had established a task force to deal with these types of issues facing cancer survivors. The task force has proposed enhancing educational programs for physicians and developing clinical practice guidelines on long-term care and monitoring of cancer survivors.
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