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ARRA Investments in Cancer Survivorship Research

Public Health Burden
Cancer is the second leading cause of death in the United States after heart disease. In 2009, it is estimated that nearly 1.5 million new cases of invasive cancer will be diagnosed in this country and more than 560,000 people will die of the disease.

Cancer Survivorship Overview
Over the past several decades, advances in cancer detection, diagnosis, and treatment have changed this once largely fatal disease into one that is chronic or readily managed for many people and curable for increasing numbers. As a result, there are more than 11 million Americans now living with a history of cancer. Survivorship research focuses on the health and life of cancer patients beyond the acute diagnosis and treatment phase. It seeks to both prevent and control adverse outcomes related to the diagnosis of cancer and its treatment. This research is of special importance because cancer survivors are at increased risk of progressive or recurring disease, second cancers, osteoporosis, cardiovascular disease, diabetes, and other serious conditions. 

Prevention and Control of Long-term and Late Adverse Effects
The survivorship research portfolio includes studies into the physiological, psychosocial, economic, and behavioral effects of cancer and its treatment on survivors and their families, with a strong emphasis on long-term and late adverse effects. ARRA funding is supporting research in this area. For example:
  • Treatment summaries, which detail the treatments received by cancer patients, and survivorship care plans have yet to be widely adopted or empirically investigated despite their foreseeable advantages. This is due, in part, to a lack of methodology and outcome measures to assess the potential benefits. In a pilot project, researchers will develop outcome measures and methodology to empirically assess the potential benefits of treatment summaries and survivorship care plans for colorectal cancer patients who are completing treatment. Findings from this pilot project will be used in a future randomized, longitudinal study to conduct a more definitive evaluation involving patients with colorectal and other common types of cancer.1  
  • In another project, researchers will investigate the long-term physiological consequences and late effects of head and neck cancer treatment. A clear understanding of these treatment-related effects will inform modification of current treatment regimens and the development of healthcare interventions directed at optimizing both long-term outcomes and rehabilitation.2
Physical Activity and Exercise
Physical inactivity is a known risk for cancer survivors, with adverse effects on physical and emotional health. Moreover, accumulating evidence indicates that physical activity interventions can afford cancer survivors substantial benefits. ARRA funds are supporting further research in this area. For example:
  • A study is investigating the effects of a partnered strength training program on the physical and emotional health of prostate cancer survivors and their spouses and on marital quality. The potential benefits of such a program could be far-reaching, since there are over 1.7 million prostate cancer survivors in the United States, and many are older and married.3
Underserved Populations
ARRA funds will be used to support efforts to better understand and address survivorship issues in underserved populations, including diverse racial and ethnic groups, individuals with limited education, and survivors with less commonly studied types of cancer. For example:
  • Evidence suggests that African American men often recover more slowly from the adverse effects of prostate cancer treatment than white men. These post-treatment difficulties can also affect the relationship with their partners. In an ARRA-supported study, researchers will test an intervention designed to enhance the coping skills of African American prostate cancer patients and their partners. The intervention will be given before treatment begins, and quality-of-life assessments will be made by the men and their partners before, during, and after therapy. The results will be compared with the results from individuals who did not receive the intervention.4
Childhood Cancer Survivors
Survival rates for childhood cancers have increased dramatically over the past few decades, due to more-effective therapies and the fact that nearly 80 percent of children with cancer are treated in clinical trials conducted by multi-specialty medical teams. However, a quarter of the deaths among childhood cancer survivors are due to late effects of treatment (e.g., second cancers, cardiac failure), pointing to the need for lifelong follow-up care. ARRA funding is supporting needed research in this area. For example:
  • A pilot study to examine the feasibility of engaging adult survivors of childhood cancer from three ethnic backgrounds (black, Hispanic, and white) more actively in their own follow-up care.5

  1. 1R03CA138077-01A1 -- Evaluating survivorship care planning in colorectal cancer -- Faul, Leigh Anne (FL)
  2. 3R01CA106908-04S1 -- Long term outcomes of head and neck cancer -- Funk, Gerry F. (IA)
  3. 1R21CA137272-01 -- Exercising together: an intervention for prostate cancer survivors and spouses -- Winters-Stone, Kerri M. (OR)
  4. 3R01CA122704-03S1 -- Prostate cancer recovery enhancement (PROCARE) for African American men -- Campbell, Lisa C. (NC)
  5. 3K23CA124451-02S1 -- Childhood cancer survivor program to empower action in care (CC-SPEAC) -- Sharp, Lisa (IL)

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