Download Is cancer A chronic Disease?

Is cancer a chronic
disease?
Prof. Dace Baltina
Riga East University Hospital
Ministry of Health
Cancer survival statistics
• 50% of adult cancer patients diagnosed in 2010-2011
in England and Wales are predicted to survive 10 or
more years.
– 46% of men and 54% of women cancer patients diagnosed
in 2010-2011 in England and Wales are predicted to
survive 10 or more years.
• Cancer survival in the UK has doubled in the last 40
years
Cancer survival statistics
• One-year age-standardised net survival for all cancers
combined in England and Wales has increased from
45% during 1971-1972 to 67% during 2010-2011 in
men – an absolute survival difference of 22 percentage
points
• In women, one-year survival has increased from 55% to
74% over the same time period (a difference of 19
percentage points).
• Overall these improvements are most likely to be due
to earlier detection and diagnosis, though advances in
treatment may also have played a role.
All Cancers Excluding Non-Melanoma Skin Cancer (C00-C97 Excl. C44): 1971-2011
Age-Standardised One-Year Net Survival, England and Wales
Please include the citation provided in our Frequently Asked Questions when reproducing this chart: http://info.cancerresearchuk.org/cancerstats/faqs/#How
Prepared by Cancer Research UK
Original data sources:
Survival estimates were provided on request by the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine.
http://www.lshtm.ac.uk/eph/ncde/cancersurvival/
Cancer survival statistics
• Types of survival rates include:
– Disease-free survival rate. This is the number of people
with cancer who achieve remission. That means they no
longer have signs of cancer in their bodies.
– Progression-free survival rate. This is the number of
people who still have cancer, but their disease isn't
progressing. This includes people who may have had some
success with treatment, but the cancer hasn't disappeared
completely.
• 80% of those with breast, prostate and skin cancer
are living for five years after diagnosis. The figure is
90% for testicular cancer.
Cancer survival statistics
• For people with cancers diagnosed in 2013, the greatest
improvement in survival chances will be in men with prostate
cancer - from 83.6% to 87.6%.
• High survival rates for prostate cancer and breast cancer are
thought to be due to the increasing number of men and
women getting their cancer diagnosed and treated at an early
stage.
• Five-year survival estimates for cancers of the brain, lung,
liver, pancreas and stomach are all below 19% for men and
22% for women.
• Pancreatic cancer for both men and women has a survival rate
of just 5.4% - the lowest in both sexes.
Facts
• Cancer may not be a one-time event.
• Cancer may come back as second and third time and
can even become a chronic (ongoing) illness that
never goes away completely.
• Although recurrent disease may not be cured, it can
often be controlled for months or even years.
Facts
• The natural tendency of some cancers is of
recurrence and remission (ovarian cancer).
• Repeating cycles can translate into survival over
many years during which the cancer can be managed
as a chronic illness.
– Repeated recurrences can become discouraging and
exhausting
– There is a question of whether to continue treating cancer
that keeps coming back - it is a personal decision on how
to handle this chronic illness
Facts
• Even those who are not cured of cancer may survive
for months or years.
• For people with controllable cancer, it can be a
chronic illness that is mostly controlled with
treatment.
Psychosocial intervention
• An important part of coping with cancer diagnosis is
recognizing emotions and feelings.
• So far there is no good evidence to support the idea
that psychosocial interventions can reduce the risk of
cancer, keep cancer from coming back, or help the
persons with cancer live longer.
• Quality of life is the principal merit of cancer
survivorship.
What do cancer patient feel?
• Guilty about their emotional responses to the illness
• May feel pressure to keep a «good attitude» at all
times, which is unrealistic
• Sadness, depression, fear, anxiety are all normal
parts of grieving and learning to cope with major life
changes – trying to ignore these feelings can make
the person with cancer feel lonely
• Feeling lonely may contribute further
marginalization.
Cancer survivorship
• Surviving cancer or “survivorship” can be defined in
different ways. Two common definitions include:
– Having no disease after the completion of treatment,
– The process of living with, through, and beyond cancer. By
this definition, cancer survivorship begins at diagnosis. It
includes people who continue to have treatment to either
reduce risk of recurrence or to manage chronic disease.
Seasons of cancer survivorship
• Acute survivorship: describes the time when a
person is being diagnosed and/or in treatment for
cancer
• Extended survivorship: describes the time
immediately after treatment is completed, usually
measured in months
• Permanent survivorship: describes a longer period,
often meaning that the passage of time since
treatment is measured in years
Cancer survivorship
• About 68% of today’s cancer survivors were
diagnosed with cancer five or more years ago.
• Approximately 15% of all cancer survivors were
diagnosed 20 or more years ago.
• More than half of cancer survivors are 65 or older.
• And an estimated 1 in 530 adults between the ages
of 20 and 39 is a survivor of childhood cancer.
Cancer survivorship
• Most cancer survivors were initially diagnosed with
common cancers:
–
–
–
–
22% of survivors had breast cancer,
20% had prostate cancer,
9% had colorectal cancer, and
8% had cervical, uterine, or ovarian cancers.
Cancer survivorship
• Improved identification of cancers that can sometimes
be found early through screening, such as:
–
–
–
–
mammography for breast cancer,
PSA test for prostate cancer,
Cervical smear for PAP tests for cervical cancer, and
Colonoscopy for colorectal cancer
• Improvements in treatment
– More effective treatment of side effects, making it possible
to give patients the planned doses of cancer drugs
– The development of new treatments, such as targeted
therapies
Cancer survivor
• Physical symptoms and conditions:
– Pain, diabetes, loss of appetite, osteoporosis,
sleeping difficulties, cardiovascular issue, skin
problems, fatigue, infertility, sexual dysfunction,
difficulty moving and secondary cancers
• Psychosocial concerns:
– Related to both social issues and mental health
– Anxiety, depression, fear of recurrence, distress,
post-traumatic stress and support issues
Cancer survivor
• Health related quality of life:
– Health impact on peoples’ well being, including
physical, mental, emotional and social functioning
• Health behaviours:
– Healthy diet, regular exercise, not smoking and
following screening programmes
• Disease progression, recurrence and survival
– Cancer treatment outcomes and toxicities,
biomarkers of survival and risk prediction models
Cancer survivor
• Patterns and quality of care:
– How does care follow national guidelines,
– Survivorship care planning and controlling,
– Adherence to treatment, insurance coverage,
patients‘ copayment, assess to care, risk
perception, the use of complementary and
alternative treatments.
• Economic impact of cancer
– Cancer impact on employment and finances
Conclusions
• Preventing secondary cancers and recurrence of
cancer whenever possible
• Promoting appropriate management following
diagnosis and/or treatment to ensure the maximum
number of years of healthy life for cancer survivors
• Minimizing preventable pain, disability and
psychosocial distress for those living with, through
and beyond cancer
• Supporting cancer survivors and their families they
need to cope with their disease