FRONTLINE CANCER: Cancer Survivor rates continue to improve

June is National Cancer Survivor Month, highlighted by National Cancer Survivors Day, which occurred June 7. At University of California, San Diego Moores Cancer Center, we marked this 28th annual celebration with a week’s worth of events intended to honor both patients who have survived their diagnoses and their supportive family and friends.

Happily, more people than ever took part in the festivities, which ranged from the annual Survivor Beach Stand Up Paddle competition on Mission Bay to seminars and receptions that included Julia Rowland, Ph.D., director of the Office of Cancer Survivorship at the National Cancer Institute (NCI).

The NCI currently defines “cancer survivor” and “cancer survivorship” based upon day of diagnosis and completion of curative therapy. It’s a change from the historical notion of cancer survivorship, which described survivorship variably as two or five years after curative therapy.

Some people are uncomfortable being identified as a “cancer survivor,” but when the term first came into broad use in the 1970s and 1980s, it heralded a historical shift from the belief that cancer was a death sentence. That perception continues to change.

Even as cancer rates decline, more and more Americans are cancer survivors. In 1971, when President Nixon famously declared “war on cancer,” there were about 3 million cancer survivors in the United States. In 2015, survivors number 14.5 million, with projections of more than 19 million by 2022.

In 1996, NCI Director Richard Klausner, M.D. (now at Illumina in San Diego) created the Office of Cancer Survivorship to recognize the growing population of cancer survivors and their unique needs. Three years later, he appointed Rowland as director.

During her visit to Moores, Rowland shared her vison of integrating survivorship concepts across the stages of cancer care. “I hope that by emphasizing the place of survivorship science along the translational continuum everyone from basic scientists to community-based researchers studying health disparities will see where their efforts might fit.” Rowland met with Barbara Parker and other Moores’ Athena breast health network leaders, a UC system-wide program that embraces this continuum for breast cancer.

Survivorship research initially focused on the dramatic successes and cures of pediatric cancers, such as certain leukemias, but it has since broadened to adult cancers and now represents an important place on the cancer control continuum. New treatments have transformed the outcome for these cancers, creating new and unique medical needs for these survivors.

“For many survivors,” said Rowland, “their biggest struggles begin post-treatment. Thus, we need to consider ways to help control some of these late effect health outcomes.”

Major cancer survivorship issues include second primary tumors, late effects of chemotherapy on the heart, bones and other organs, and impactful psychosocial issues. Much of adult survivorship research has focused on the predominant tumor groups of breast and prostate cancer, although there are top priorities for survivorship studies across all cancer types.

The impact of the Affordable Care Act and its potential ability to ameliorate disparities in cancer outcomes has generated considerable interest in survivorship research. While the act provides individuals with preexisting conditions with new ways to obtain insurance, details of pay models or methods of bundling care for survivors remain unresolved. It is anticipated that improved access to care by underserved populations will further improve survivor rates.

At Moores, we are specifically investigating new early detection advances for pancreatic, ovarian, hepatic and lung cancers. Last month, Moores researchers published study results that could significantly impact our ability to detect early stage ovarian cancer. Specifically, they were able to detect isoforms — bits of genetic material that distinguish ovarian cancer cells from normal cells.

New treatment strategies have also increased survivorship. Targeted molecular therapies are now part of the oncologist’s arsenal. Precision medicine, based upon a patient’s DNA, is becoming routine. Technologies such as imaging, radiation and surgery are constantly evolving, achieving better results with fewer adverse effects.

In 2010, the first cancer vaccine was approved by the Food and Drug Administration for advanced prostate cancer. A different vaccine is now being studied in low-risk active surveillance (watchful waiting), an NCI-sponsored, multicenter prostate trial led by Moores investigators. Other vaccines are in the pipeline for non-small cell lung cancer, pancreatic cancer, ovarian cancer, melanoma and multiple myeloma. We are vigorously pursuing other encouraging leads in immunotherapy, which seeks to bolster the body’s innate defense mechanisms to destroy or disable cancer cell growth and is achieving long-term survival and cure in very advanced and previously incurable stages of melanoma, lung cancer and certain other cancers.

Rowland stresses the importance for survivors and their health care teams to create a “plan for success” based upon a rehabilitative model to deliver post-cancer care. The model should include both primary care to optimize recovery and lifestyle interventions, such as exercise and nutrition that can reduce subsequent cancer risk and recurrence.

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