ST. PETERSBURG, FloridaAs cancer survival increases, outcomes research must focus on both quality of life and length of survival, and must define and quantify late effects of cancer treatment, Noreen Aziz, MD, PhD, MPH, said at the Late Effects of Normal Tissues (LENT) IV workshop on late effects criteria and applications.
"The remarkable progress over the last few decades in cancer detection and early treatment is a success story that comes with a challenge: how to treat the effects of cancer treatment seen in survivors," said Dr. Aziz, program director of the Office of Cancer Survivorship, National Cancer Institute (NCI). "Our mandate and goal for professionals dealing with cancer survivors is to enhance the quality as well as the length of survivorship."Cancer has become for many a curable or chronic illness. There are currently 8.9 million cancer survivors in the United States facing delayed toxicity now or in the near future (see Figure 1). Statistics suggest that by 2010, one of every 250 adults aged 20 to 29 will be a survivor of childhood cancer. Apart from other causes of death, 5-year survival from cancer is now 61% for adults and nearly 75% for those under age 19 at diagnosis.
Cancer survivorship research attempts to identify, examine, prevent, and control adverse effects related to cancer diagnosis and treatment outcomes, and to provide a knowledge base allowing optimal health after cancer therapy. Since 1996, Dr. Aziz’s group has stimulated such research at the NCI and also collaborated with the Department of Defense and various institutes at the National Institutes of Health.
"How do we enhance research in this field?" Dr. Aziz asked. "First we articulate our gaps in knowledge." Missing pieces of the puzzle include cancer types that are common but not well studied, outcomes research specific to age and cultural disparities, and appropriate assessment instruments.The best studied primary cancer is breast cancer, accounting for about 41% of survivorship grants, while about 22% of research dollars are spent on multiple or mixed cancers (see Figure 2). Although colorectal cancer is the third most prevalent cancer, it receives only 3% of research funding, and very little is known about long-term effects, Dr. Aziz said.
Other primary tumors, even common ones like prostate cancer, are also understudied. Greater long-term survival in head and neck and hematologic cancers now demands more survivorship research in these areas as well.