"The American Association for Cancer Research has released its second
Annual Report on Cancer Survivorship in the United States. The report, published in the AACR’s journal
Cancer Epidemiology, Biomarkers & Prevention,
shows that as of January 2012, there were approximately 13.7 million
cancer survivors in the United States, a number that is expected to rise
by 31 percent to 18 million by 2022."(NCSD)
It is quite apparant that one of the shame in Oncology practice is the poor services that we provide to our cancer survivors. Given the current state of knowledge, it is evident that what we do for survivor is small, fragmented and insufficient! And the service is more insufficient in patient who had been the more treated.
If one had surgery alone, the moral toll of losing a breast, burden of future relationship, perceived Disfiguration and related psychological detrimental effect is a tremendous burden to cope with...Consequences of true anatomic sequelae of surgeries are countless and a huge burden affecting the lives of survivors. And there are not enough trained psychologist or internists for that matter to meet the demand imposed by cancer on survivors.
If a survivor had Radiation, an additional toll occurs. Now on top of thyroid dysfunction, Xerostomia, chronic fatigue, and disfiguration, secondary cancer is added. Suppression of bone marrow after a localized radiation has always pointed out that although Radiation is localized, it has systemic implications. That is some altered protein escape the area to induce deleterious effects / stressful events at the distance. fatigue and sometimes nausea result from Radiation. Myocardial infarction, loss of hair and salivation are most of the time a result of a direct exposure to Radiation, and Anemia/Myelodysplasia can result from pelvic radiation.
And if chemotherapy was part of the treatment, and particularly if it contained Cisplatin or Alkylating agents, Leukemia and secondary cancers become a real possibility. Lung, renal and hearing toxicities become real. Chemotherapy induced encephalopaties of various level are present. Thyroid and fertility disturbances, Dysplasias or all kinds, and the overall neuro-psychiatric background is disturbed. Globally all senses are disturbed. Alterations of the immune system are poorly evaluated and understood.
Where we fail is in our correct evaluation of these disturbances and risk of future events in order to make a difference in the life of survivors. Our biomarkers are not up to what the should be for cancer early detection of secondary cancers,minor but significant side effcts are poorly measured and meaningful preventive or therapeutic measures are often lacking!
The point is that under the satisfaction of response to therapy, we fail to address what is to come for our survivors who often found themselves alone and unprepared to what is to come. The oncologist challenge is compounded by the fact that some of the services needed are not covered by insurers unless packaged in a certain smart fashion. Insurers who have paid for the treatment, want to run from the demanding patients! The lack of evidence based supportive treatment does not help either!
As to secondary cancers:
The point is that we know which cancers develop after chemotherapy
AML (CBF LIKE MOLECULE, GENETIC PROFILE OF BONE MARROW 1 YEAR POST TREATEMT?)
Myelodysplasia (genetic profile of Bone marrow
Colon Cancers( Microsattelite, MUC,
Lung cancers (HIF-1a, MUC...,EGFR)
Breast Cancers (WISP3,BRCA1,2...P53 mutation)
Lymphoma (appropriate gene translocations)
Sarcoma (WT-1, secretases)
and even Melanoma (p16,KIT,PTEN
But No one is delving into preventive detection of of genes!
Renal toxicity (NPHS2 gene, ACTN4
Ototoxicity same as renal (may be!)
scars (Metallopreoteases and their inhibition)
Many studies needed for "PROOF OF CONCEPT"
The skeptical will add "is this going to improve survival" just be in the shoes of survivors once and you will see the need for this testing!
