As the number of cancer survivors in the U.S. continues to rise and the age at diagnosis for some cancers appears to be shifting younger, the need for long-term survivorship care is more urgent than ever.
This is particularly true for the working-age adult population—those between 18 and 64 years old—who may live for decades after they complete treatment, but whose unique survivorship needs aren’t always met today.
Unfortunately, only a portion of WAA cancer survivors receive up-to-date guidance and services to live healthy lives after cancer, and few physicians are properly trained to care for them.
WAA cancer survivors are often faced with long-term effects of cancer treatment, such as persistent neuropathy and fear they may be diagnosed with a second malignancy or have a recurrence of their cancer.
They are also warned about the possible development of late effects, which are chronic conditions that may arise years after the end of treatment and often worsen over time, such as cardiovascular disease or hormone problems (endocrinopathies) like premature ovarian insufficiency. These late effects can significantly impact work, family, and social roles, and lead to a diminished sense of wellbeing.
WAA survivors may also face damage to personal, professional, and parenting aspirations that ripple throughout the workforce and society.
Survivorship care procedures are more established for younger adults and those who were diagnosed as children or adolescents. Through concerted efforts and the establishment of guidelines for care, younger adults are more likely to receive a care plan designed to offer the best chances of minimizing long-term morbidity and mortality through early identification and intervention. WAAs with an expected lifespan of over 10 years would benefit from similar proactive efforts to optimize long-term health.
The discrepancy in preventive medical care for individuals diagnosed with cancer over 40 and under 40 years of age may be most striking for CVD. Cancer survivors are at a significantly higher risk of dying from CVD compared to the general U.S. population.
Risk factors include age at treatment (higher risk associated with younger age, excluding geriatric populations), use of therapies that can damage the heart (e.g., radiation to the chest, anthracyclines drugs that are frequently used in chemotherapy protocols, 5-fluorouracil often used for colon cancer, and trastuzumab initially used for breast cancer and currently also for many solid tumors), and the presence of pre-existing cardiovascular conditions.
Due to the growing population of WAA cancer survivors and the increasing recognition of long-term treatment effects, we must reevaluate our approach to preventive care for WAAs.
Lifelong, proactive CVD screening recommendations for survivors diagnosed at age 40 or younger facilitate early detection and management of potential cardiovascular issues.
In contrast, CVD guidelines are currently limited for WAA diagnosed after age 40. Those that exist aren’t followed consistently at the point of care, and assessments are typically reactive after symptoms or secondary risk factors emerge. This approach misses the window for early detection and intervention, potentially exacerbating health issues and harming their long-term health outcomes.
Due to the growing population of WAA cancer survivors and the increasing recognition of long-term treatment effects, we must reevaluate our approach to preventive care for WAAs. Admittedly, WAA survivorship care is complicated, because adults may develop other health problems unrelated to cancer such as hypertension and diabetes.
A novel approach is needed to provide long-term, personalized survivorship care that is based on age at exposure, treatment, comorbidities, family history, and genetics. Crucially, the patient must also be acknowledged as an active participant in care.
We recognize that the absence of long-term preventive care guidelines for adult cancer survivors largely stems from the lack of prospective, randomized trials involving large cohorts and comparisons to peers without cancer.
However, these studies take years to decades to complete, and are often underfunded compared to treatment interventions. While we wait for the data, primary care and oncology clinicians can take immediate action by offering risk-based, preventive guidance to their patients who are cancer survivors.
A more proactive approach to survivorship care—one that prioritizes early detection and timely intervention—has the potential to transform the landscape of long-term cancer care and improve the lives of millions of U.S. cancer survivors.
