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      Physical and Psychological Long-Term and Late Effects of Cancer

      research-article
      , PhD 1 , 2 , , PhD 3 , 4 , , PhD 5
      Cancer
      cancer, survivorship, quality of life, long-term effects

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          Abstract

          The number of long-term cancer survivors (≥5 years after diagnosis) in the U.S. continues to rise, with more than 10 million Americans now living with a history of cancer. Along with such growth has come increasing attention to the continued health problems and needs of this population. Many cancer survivors return to normal functioning after the completion of treatment and are able to live relatively symptom-free lives. However, cancer and its treatment can also result in a wide range of physical and psychological problems that do not recede with time. Some of these problems emerge during or after cancer treatment and persist in a chronic, long-term manner. Other problems may not appear until months or even years later. Regardless of when they present, long-term and late effects of cancer can have a negative effect on cancer survivors’ quality of life. This article describes the physical and psychological long-term and late effects among adult survivors of pediatric and adult cancers. The focus is on the prevalence and correlates of long-term and late effects as well as the associated deficits in physical and emotional functioning. In addition, the emergence of public health initiatives and large-scale research activities that address the issues of long-term cancer survivorship are discussed. Although additional research is needed to fully understand and document the long-term and late effects of cancer, important lessons can be learned from existing knowledge. Increased awareness of these issues is a key component in the development of follow-up care plans that may allow for adequate surveillance, prevention, and the management of long-term and late effects of cancer.

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          Most cited references102

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          Chronic health conditions in adult survivors of childhood cancer.

          Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors. The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition. Survivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition. Survivors of childhood cancer have a high rate of illness owing to chronic health conditions. Copyright 2006 Massachusetts Medical Society.
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            Prevalence of depression in patients with cancer.

            Depression is the psychiatric syndrome that has received the most attention in individuals with cancer. The study of depression has been a challenge because symptoms occur on a broad spectrum that ranges from sadness to major affective disorder and because mood change is often difficult to evaluate when a patient is confronted by repeated threats to life, is receiving cancer treatments, is fatigued, or is experiencing pain. Although many research groups have assessed depression in cancer patients since the 1960s, the reported prevalence (major depression, 0%-38%; depression spectrum syndromes, 0%-58%) varies significantly because of varying conceptualizations of depression, different criteria used to define depression, differences in methodological approaches to the measurement of depression, and different populations studied. Depression is highly associated with oropharyngeal (22%-57%), pancreatic (33%-50%), breast (1.5%-46%), and lung (11%-44%) cancers. A less high prevalence of depression is reported in patients with other cancers, such as colon (13%-25%), gynecological (12%-23%), and lymphoma (8%-19%). This report reviews the prevalence of depression in cancer patients throughout the course of cancer.
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              Posttraumatic growth following breast cancer: a controlled comparison study.

              Cancer may be viewed as a psychosocial transition with the potential for positive and negative outcomes. This cross-sectional study (a) compared breast cancer (BC) survivors' (n = 70) self-reports of depression, well-being, and posttraumatic growth with those of age- and education-matched healthy comparison women (n = 70) and (b) identified correlates of posttraumatic growth among BC survivors. Groups did not differ in depression or well-being, but the BC group showed a pattern of greater posttraumatic growth, particularly in relating to others, appreciation of life, and spiritual change. BC participants' posttraumatic growth was unrelated to distress or well-being but was positively associated with perceived life-threat, prior talking about breast cancer, income, and time since diagnosis. Research that has focused solely on detection of distress and its correlates may paint an incomplete and potentially misleading picture of adjustment to cancer.
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                Author and article information

                Journal
                0374236
                2771
                Cancer
                Cancer
                Cancer
                0008-543X
                1097-0142
                12 February 2020
                01 June 2008
                28 February 2020
                : 112
                : 11 Suppl
                : 2577-2592
                Affiliations
                [1 ]Behavioral Research Center, American Cancer Society, Atlanta, Georgia
                [2 ]Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
                [3 ]Survivorship Program and Biobehavioral Sciences Department, Fred Hutchinson Cancer Research Center, Seattle, Washington
                [4 ]Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
                [5 ]Department of Behavioral Science, University of Kentucky College of Medicine, University of Kentucky, Lexington, Kentucky
                Author notes
                Address for reprints: Kevin D. Stein, PhD, Behavior Research Center, American Cancer Society, 250 Williams Street, Atlanta, GA 30303-1002; Fax: (404) 929-6832; kevin.stein@ 123456cancer.org
                Article
                PMC7047657 PMC7047657 7047657 nihpa1558481
                10.1002/cncr.23448
                7047657
                18428205
                f288af66-0d66-46c4-92e5-7aa7b8c3dd72
                History
                Categories
                Article

                long-term effects,quality of life,survivorship,cancer
                long-term effects, quality of life, survivorship, cancer

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