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Chronic and Late Effects of Cancer and Its Treatment
Few of our current cancer treatments are benign; most carry the potential to cause adverse long-term and late effects. As children and adults with a history of cancer live longer, and data from research studies supported by NCI mature, more of these risks are being documented and reported. Risks include but are not limited to neurocognitive problems, premature menopause, cardiorespiratory dysfunction, sexual impairment, infertility, chronic fatigue and pain syndromes, and second malignancies. Research shows that many survivors also experience significant negative psychosocial outcomes, including fear of recurrence, poor self-esteem, anxiety and depression, employment and insurance discrimination, and relationship difficulties.
Interventions
A second vital area of active research addresses the development and application of interventions that will prevent or reduce adverse outcomes of cancer and its treatment and/or promote optimal health, and physical, psychological, and social functioning. Awareness within the investigator community of the importance of this research is reflected in the fact that almost 40 percent of the currently funded grants in the survivorship area contain an intervention component.
Healthy Lifestyle and Behaviors
A relatively new but fast-moving focus of survivorship research is on the lifestyle choices and behaviors of survivors following cancer treatment. This includes research on the prevalence of behaviors that affect cancer risk (e.g., physical activity, smoking, alcohol use, sun exposure) and promote well-being (e.g., exercise, vegetable consumption), as well as research on interventions to improve health outcomes after cancer and its treatment. Many have argued that the threat to life imposed by a cancer diagnosis can be life altering, particularly in the area of health behaviors. Targeting the risk for physical inactivity following cancer and its corresponding adverse impact on weight and health, a number of researchers are using exercise interventions to improve survivors' emotional and functional well-being. While it is not clear if these types of interventions will alter the course of cancer (specifically, rate of or time to recurrence or death), they hold the promise of reducing cancer-related morbidity and improving quality of life. They also appear to have enormous appeal to survivors eager to reduce the perceived stress in their lives and to "take control" of their bodies after cancer.
Benefit Finding and Posttraumatic Growth
Historically, survivorship research has sought to identify and address the adverse physical and psychosocial consequences of the disease. An emerging body of evidence suggests that cancer survivors, similar to survivors of other traumatic life events, also experience positive life changes following a cancer diagnosis, and further, that these positive effects of cancer frequently coexist with the negative. Studies have shown that many survivors identify their illness experience as an event that has the potential to help them make personally meaningful health and lifestyle changes. They suggest that for many, the ability to identify positive aspects of the cancer experience may help in ultimate adjustment. Several studies continue to examine how perceptions of benefit-finding and/or posttraumatic growth are related to physiological and psychosocial adjustment.
Family
We are beginning to appreciate the impact of cancer on the functioning and well-being of the millions of family members affected by this illness, many of whom may themselves be at increased risk for cancer due to shared cancer-related genes, lifestyle, and/or toxic exposures. Although social support is widely recognized as an important buffer to negative health events, attention to the role of family caregivers and other household members on survivors' health related outcomes, as well as the impact of cancer on the health status of family members themselves, is only just beginning to take off. Studies continue to examine or address the impact on health and well-being of cancer treatment and the sequelae of cancer survivorship on a family unit, family member, or caregiver.
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