Many cancer survivors live longer because of improved early detection, treatment, and oncologic outcomes. They’re more likely to get sick or die from things other than their original cancer, with 2/3 of all cancer patients living more than five years after being diagnosed.
However, the rising number of long-term cancer survivors over 65 offers special difficulties for American oncologists and primary care doctors in organizing and prioritizing patient care. These issues are expected to worsen as the nation’s population ages and more people suffer from increasing cancer risks and other aging-related health issues. The new study examines competing oncologic and nononcologic risks in long-term adult cancer survivors.
A new study led by Yale University researchers looked at cancer- and noncancer-related death rates of long-term adult cancer survivors to better understand and quantify the health hazards of the disease. The findings could help reduce large-scale care inefficiencies and improve the quality of care for long-term cancer survivors with specific cancer and noncancer health demands.
Yale School of Public Health Associate Professor Michaela Dinan, co-leader of the Cancer Prevention and Control Research Program at the Yale Comprehensive Cancer Center and the study’s senior author, said, “The population is aging, and people who have cancer are living longer, What we’re trying to do is make sure that this population is receiving efficient care and also the best quality of care.”
The study included 628,000 individuals diagnosed with breast, prostate, or colorectal cancer between January 1, 2003, and December 31, 2014, who got therapy and were still living five years later. The patients were divided into three risk categories depending on their risk of dying from their cancer diagnosis: low, middle, and high. Low-risk patients were 65 or older and in stage I for breast and colorectal cancer, high-risk patients were younger than 65 and in stages II or III, and intermediate-risk patients were the remainder. The classifications for prostate cancer were identical, except that the Gleason score was used instead of the cancer stage.
A study found that high-risk patients, except for prostate cancer, are more likely to die from their initial cancer, while low-risk patients are at least three times more likely to die from something else. Low-risk breast cancer patients were nearly seven times more likely to die from a cause other than their initial cancer. In comparison, low-risk prostate cancer patients were nine times more likely to die from something other than their initial cancer diagnosis.
The researchers discovered that heart disease caused one-fourth of all non-cancer deaths. The major causes of death were Alzheimer’s disease, chronic obstructive pulmonary disease, and cerebrovascular illness.
The research provides crucial information for the treatment of long-term cancer survivors since, in the US, it is typical for primary care doctors to refer cancer patients to oncologists as soon as they are diagnosed. However, the long-term viability of this model and whether it provides the most significant treatment for patients is a growing concern. Long-term survivors also have more complex health demands than the average population, and not all of those needs are cancer-related.
She said, “Their original breast or prostate or colon or rectal cancer doctor is not the appropriate person to monitor them for those health conditions.”
Risk-adjusted care models could be an effective technique for effectively distributing treatment between oncologists and primary care providers. These models are considered significant research areas by the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. The current study is the first phase in Dinan’s and her research team’s bigger American Cancer Society grant to build risk-prediction algorithms for informing long-term survivor care.
The researcher said, “Personalized risk stratification is feasible, and it can help prioritize goals of survivor care management.”
This study has a number of drawbacks. First, only internal data validation was used to validate the models. Second, the SEER database contained just a few clinical and treatment-related characteristics.
In conclusion, This study is the first to investigate the hazards of cancer treatment for long-term adult survivors, providing practical advice on the need for continuous primary and oncologic-focused care.
Journal Reference:
- Madhav KC, Jane Fan, et al. Relative Burden of Cancer and Noncancer Mortality Among Long-Term Survivors of Breast, Prostate, and Colorectal Cancer in the US. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.23115