What challenges do the millions of people who have beaten cancer face as survivors?

Here’s a statistic to smile about: the number of cancer survivors in the U.S. is expected to surge from today’s 14.5 million to nearly 19 million by 2024, according to the American Cancer Society (ACS). More people are beating cancer, but what do their lives look like when they reach survivor status?

According to an article published in CA: A Cancer Journal for Clinicians, cancer incidence rates have been on the decline for the past decade, but the number of cancer survivors is growing because of early detection and more effective treatments.

The report said that the three most common types of cancer in men who’ve had the disease are prostate cancer (43 percent), colorectal cancer (9 percent), and melanoma skin cancer (8 percent). In women, 41 percent of women who have ever had cancer have had breast cancer, while 8 percent have had uterine cancer and 8 percent have had colorectal cancer. Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer in both men and women, but it has a lower survival rate.

In 2024, the report said that the distribution of common cancers will probably be about the same as it is today.

The report also found that 64 percent of cancer survivors were diagnosed five or more years ago, and 15 percent were diagnosed with the disease more than 20 years ago. It also states that 46 percent of cancer survivors are over the age of 70, while 5 percent are under the age of 20. Most people who have survived prostate cancer—that’s 62 percent of survivors—are over the age of 70, but only 32 percent of melanoma survivors are in that age group.

By January 1, 2024, there will be about 19 million people—9.3 million men and 9.6 million women—who are cancer survivors, the report stated.

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“The growing number of cancer survivors in the U.S. makes it increasingly important to understand the unique medical and psychosocial needs of survivors,” said Carol DeSantis, MPH, an epidemiologist with the ACS and lead author of the report.

“Despite the fact that awareness of survivorship issues has increased, cancer survivors face numerous, important hurdles created by a fractured health care system, poor integration of survivorship care, and financial and other barriers to quality care, particularly among the medically underserved,” she added. “An important first step in addressing these challenges is to identify ‘best practices’ for the delivery of quality post-treatment cancer care.”

Dr. Abdulrahman M. El-Sayed, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, said increasing levels of cancer survivorship are promising. However, survivors may face adverse health outcomes, including psychological distress.

“Many of these cancers can be disfiguring, like breast cancer, and the self-image issues following that can also have adverse consequences,” El-Sayed said. “Breast cancer survivors often require estrogen receptor blockers, which can interfere with sexual function, and cause symptoms of menopause.”

Prostate cancer survivors may face impotence; in fact, 70 percent of survivors have that problem.

Colon cancer has a number of potential side effects as well, El-Sayed said. They can include chronic vitamin deficiency, chronic diarrhea, or requiring a stoma or surgically created colonic opening.

Chemotherapy and radiation can also take its toll on the human body; in fact, cancer is a side effect of radiation because it can trigger DNA mutations. It can also induce diabetes in some patients, as well as deteriorate tooth enamel and cause damage to major organs, including the heart, liver, kidneys, and lungs. Cancer survivors who have had surgery to remove tumors may also have issues with their lymphatic systems, El-Sayed said.

Dr. Maurie Markman of the Cancer Treatment Centers of America, added that some patients may have residual side effects from chemotherapy drugs, such as numbness in the fingers and toes.

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Physicians said that the system must evolve as more survivors emerge.

Sam Alstein, D.O., the medical director of Beth Israel Medical Group at Mount Sinai Health System in New York City, said that primary care physicians will have to devote more time and effort to cancer prevention by promoting cancer-reducing treatments and lifestyle changes, along with electronic medical records to improve the screening process.

Survivors and their primary care doctors will have to understand the guidelines for post-cancer care to evaluate how likely it is that the cancer will return, as well as the effects of cancer treatments.

“The cancer screening guidelines themselves need improvement to more accurately diagnosis disease in a way that enhances not only the length of life but also the quality of life with cancer,” Alstein said.

Alstein said cancer care advancements mean that many survivors will meet the criteria for highly individualized treatment regimens.

“Patient-centered care that puts the person with cancer in the middle of their team of specialty and primary care physicians and their support staff is a developing focus for the future of cancer care,” he said.

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