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National Cancer Institute U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Julia H Rowland, PhD Director Office of Cancer Survivorship National Cancer Institute U13 – Cancer and Aging Symposium Chicago, Illinois May 13, 2015 Definitional Issue: Who is a Cancer Survivor? Philosophically, anyone who has been diagnosed with cancer is a survivor— from the time of diagnosis to the end of life Caregivers and family members are also cancer survivors (Source: NCCS, 1986) Definitional Issue: What do we mean by Cancer Survivorship? Cancer survivorship [research] focuses on the health and life of a person with a history of cancer beyond the acute diagnosis and treatment phase…and encompasses the physical, psychosocial, and economic sequelae of cancer diagnosis and its treatment among both pediatric and adult survivors of cancer. It also includes within its domain, issues related to health care delivery, access, and follow up care, as they relate to survivors. Source: Office of Cancer Survivorship, NCI NIH/DCCPS Model (modified from Abrams with input from GW colleagues) National Cancer Institute Long-Term or Chronic Effects of Cancer Treatment Physical/Medical (e.g., pain, fatigue, memory problems, lymphedema, sexual impairment, amputations) Psychological (e.g., depression, anxiety, uncertainty, isolation, altered body image) Social (e.g., changes in interpersonal relationships, concerns regarding health or life insurance, job lock/loss, return to school, financial burden) Existential and Spiritual Issues (e.g., sense of purpose or meaning, appreciation of life) National Cancer Institute Cancer Survivors at Increased Risk for Late Effects Disease recurrence/ new cancers Cardiovascular disease Obesity/Diabetes Osteoporosis Functional decline Poor quality of life Estimated and projected number of cancer survivors in the United States from 1977-2022 by years since diagnosis Source: de Moor et al, CEBP 2013 20 18 16 Number in Millions 14 12 15+ years 10 10-<15 years 5-<10 years 8 1-<5 years <1 6 4 2 0 1977 1982 1987 1992 1997 2002 Year 2007 2012 2017 2022 60% of survivors are ≥ 65 yrs Millions Projected Number of US cancer cases for 2000 through 2050 based on projected census population estimates and age-specific cancer incidence from cases diagnosed in 1995-1999 in the SEER and NPCR areas. 3.0 2050, 2.65 Million 2040, 2.48 Million 2030, 2.25 Million 2.5 2020, 1.91 Million 2.0 Observed: 2014, 1.67 Million 85+ 75-84 1.5 65-74 50-64 <50 1.0 0.5 0.0 2000 2010 2020 2030 2040 2050 Year Source: Annual Report to the Nation, Featuring Implications of Age and Aging on U.S Cancer Burden, Cancer, 2002. National Cancer Institute Priorities for NCI Conduct studies among older populations of survivors! --Who are diverse with respect to: cancer type, race/ethnicity, geography, SES, language National Cancer Institute Priorities for NCI Conduct studies among older populations of survivors Understand the interface between not only cancer and aging, but also aging and cancer National Cancer Institute Priorities for NCI Conduct studies among older populations of survivors Understand the interface between cancer and aging, and aging and cancer Examine post-treatment care pathways for older survivors National Cancer Institute Institute of Medicine Report Establish survivorship as a distinct phase of care Implement survivorship care plans Develop and evaluate evidence-based clinical practice guidelines Institute quality of survivorship measures Develop and test models of care Build bridges between oncology and primary care Strengthen professional education Expand use of psychosocial and community support services Ensure survivors have access to needed care Invest in survivorship research Executive Summary From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, D.C.: The National Academies Press; 2006. National Cancer Institute Priorities for NCI Conduct studies among older populations of survivors Understand the interface between cancer and aging, and aging and cancer Examine post-treatment care pathways for survivors Promote healthy lifestyles among older survivors Growing number of cancer survivors who… Are living longer Are older, and also aging Often gain weight, stop exercising during Rx Are at risk for a number of co-morbid health conditions (and may also have a history of others) 6. Are asking for help in reducing cancer-related morbidity and mortality 7. Can benefit from health promoting inventions 1. 2. 3. 4. 5. National Cancer Institute Cancer Trends Progress Report – April 2015 In 2012, 30.6% of cancer survivors aged 20 and older were obese National Cancer Institute Many Survivors will NOT die of their Cancer! • Older breast cancer survivors: more likely to die of CVD than breast cancer (Patnaik, Breast Cancer Research 2011, 13(3):R64) • 15-year prostate cancer-specific mortality: 5.3% vs. 30.6% non CaP-mortality (Shikanov, Prostate Cancer Prostatic Dis. 2012 Mar;15(1):106-10) • Testicular CA survivors treated w/ XRT under age 35: 1.7 x more likely to die of circulatory Dz than general population (Fossa, JNCI 2007 April 4; 99(7), 533-44) • Australian survivors 50% more likely to die of non-cancer causes than general population (Baade, Cancer Causes & Control 2006 April, 17(3), 287-97) National Cancer Institute Priorities for NCI Conduct studies among older populations of survivors Understand the interface between cancer and aging, and aging and cancer Examine post-treatment care pathways for survivors Promote healthy lifestyles among older survivors Examine and address the impact of cancer on informal cancer caregivers NIH Survivorship Research Grants in FY2012 by Study Design (n=187) Number of NIH Survivorship Grants in FY12 by Cancer Site (n=142) Number of Grants NIH Survivorship Research Grants in FY2012 by Primary Study Outcome (n=142) National Cancer Institute Parent and Omnibus Funding Mechanisms: PAR 14-007 (R03): NCI Small Grants Research Program PAR 13-146 (R21): NCI Exploratory/Developmental Research grant PA 13-302 (R01): NIH Research Project Grant PA-12-275: Examination of Survivorship Care Planning Efficacy and Impact Purpose: stimulate Forresearch R21s, that will: 1) develop and test metrics for evaluating see the impact of survivorship care planning; 2) evaluate the impact of survivorship care PA-12-274 planning on cancer survivors' morbidity, self-management and adherence to care recommendations, utilization of follow-up care, and on systems outcomes, such as associated costs and impact on organizations implementing care planning; and 3) identify models and processes of care that promote effective survivorship care planning. http://grants.nih.gov/grants/guide/pa-files/PA-12-275.html Physical Activity and Weight Control Interventions: Effects on Biomarkers of Prognosis and Survival PAR-12-228 (R01) and PAR-12-229 (R21) Purpose: To encourage transdisciplinary and translational research that will identify specific biological or biobehavioral pathways through which physical activity and/or weight control (either weight loss or avoidance of weight gain) may affect cancer prognosis and survival. Research applications must test the effects of physical activity or weight control or both interventions on biomarkers of cancer prognosis among cancer survivors identified by previous animal or observational research, which may include but are not limited to intervention-induced changes in sex hormones, insulin or insulin-like growth factors or their binding proteins, insulin resistance, glucose metabolism, leptin and other adipokines, immunologic or inflammatory factors, oxidative stress and DNA damage or repair capacity, angiogenesis, or prostaglandins. National Cancer Institute Advancing Interventions to Improve Medication Adherence: PA 14-334 (R01) and PA 14-335 (R21) Purpose: To encourage innovative new medication adherence research. Adherence is inextricably connected to the efficacy of medical treatment regimens and therefore to health outcomes. Although adherence has been the topic of considerable research for the last two decades, continuing evidence of sub-optimal medication adherence in many chronic conditions highlights the need for transformative research in this area. This FOA will support research to test interventions with the potential to significantly improve medication adherence in individuals with one or more chronic health conditions. National Cancer Institute Hhh http://cancercontrol.cancer.gov/ocs