As Cancer Survivors Increase, Hardships Remain

In In The News by Barbara Jacoby

By: Gaby Galvin

From: usnews.com

A growing and aging population will lead to more people who have battled the disease, highlighting a need for stronger support for survivors.

The number of cancer survivors in the U.S. is set to rise by more than 5 million by 2030, according to a new analysis from the American Cancer Society.

Researchers estimate more than 16.9 million people with a history of cancer were alive at the beginning of 2019, and project that total will exceed 22.1 million by 2030. The increase is expected to be driven in part by demographic shifts, according to the study, published Tuesday in the American Cancer Society’s flagship journal.

“Because the population is growing and aging, even though the (cancer death) rate is declining, the absolute number of people diagnosed with cancer – and surviving it – is going to increase in the future,” says Robin Yabroff, co-author of the report and senior scientific director for health services research at the American Cancer Society.

About two-thirds of current cancer survivors are 65 or older, according to study estimates, and 68% were diagnosed at least five years ago. Yabroff says the growing number of survivors will “absolutely” carry implications for the health care sector – especially the Medicare program, the primary health insurer for people 65 and older – because side effects from cancer and its treatment can surface months or years after active treatment ends.

Cancer-related problems such as chronic pain, fatigue and other health issues also can vary by a patient’s particular diagnosis and characteristics. The most common types of cancers among male survivors are prostate, colon and rectum, and skin melanoma. Among female survivors, breast, uterine, and colon and rectum cancers are the most common.

Taken together, these cancers account for more than 5.1 million cases among males and 5.4 million cases among females in 2019, the estimates show.

“They’re a large group and they have diverse needs,” says Dr. Maryam Lustberg, an associate professor of medicine at Ohio State University and director of survivorship at the university’s Comprehensive Cancer Center. “Some gains have been made, due to better screening as well as better treatments, but a lot more work needs to be done.”

Major challenges impacting cancer survivors include poor coordination between oncology and primary care providers, physician workforce shortages and a lack of knowledge about cancer survivors’ needs, the report notes. Access to high-quality care also is a barrier for some patients.

These gaps exist “across the board, but like with other services, those populations that are medically underserved may have more challenges in their transition to survivorship,” Yabroff says.

For most cancers, the five-year relative survival rate is lower for black patients than white patients – even after controlling for the stage of a patient’s cancer at diagnosis – and much of that disparity appears tied to differences in health insurance coverage, the report notes.

After completing treatment, black cancer survivors are more likely to report poorer physical functioning and may have less access to culturally relevant support services and targeted resources than white cancer survivors. Black survivors also are more likely to receive “inadequate post-treatment surveillance” for cancer recurrence, the report says.

Racial and ethnic minorities also tend to be underrepresented in large clinical trials – “a major barrier to health equity in cancer treatment,” according to the study.

Financial barriers to care can hit across groups of survivors. A separate report co-authored by Yabroff that was published this month by the Centers for Disease Control and Prevention indicates that among survivors ages 18 to 64, 25% said they had trouble paying medical bills, and 33% said they were worried about these expenses.

On average, cancer survivors had higher out-of-pocket medical expenses than other adults, and cancer survivors who were uninsured were more likely to report financial hardship than those with health insurance. Uninsured cancer survivors also are less likely to receive preventive services like screenings, Yabroff notes.

“Regardless of insurance status, or even across most of the socioeconomic status groups, people are really feeling the burden of cancer care – high copays (as well as) the ability to return to the same line of work that they were able to do before,” says Lustberg, who was not involved with the CDC study.

While surviving cancer may not be as possible for patients dealing with later stages in which the disease has spread, efforts to improve health and quality of life for survivors also should include these metastatic patients, Lustberg says, because they need similar support.

“The goal is that we are really having a holistic view of what a patient needs,” she says. “Not just focusing on cancer drugs, but their psychosocial needs, their spiritual needs, actively managing symptoms, thinking about long-term toxicities and focusing on health promotion.”

As the health care system overall shifts from a focus on services to a focus on outcomes, these holistic types of models for cancer care are “beginning to emerge,” the report notes, citing more integration among primary care and cancer rehabilitation for patients with a history of cancer, as well as an emphasis on supporting their caregivers.

As more of these models show strong outcomes, the report says they should be considered at all levels – patient, provider, health system and policy – to “help cancer survivors live longer and healthier lives.”

“Improving survivorship care is really critical,” Yabroff says.