Download Who is a Cancer Survivor? - Cancer and Aging Research Group

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
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http://cancercontrol.cancer.gov/ocs