Aug. 31, 2004 -- For cancer survivors, physical and emotional problems continue long after treatment ends. In fact, even long-term cancer survivors fare worse -- in terms of quality of life -- than people who have not faced cancer, according to new research.
These results, from a new nationwide study, appear in this month's issue of the Journal of the National Cancer Institute.
Hidden Costs of Cancer
Other studies have looked at economic costs of cancer care. But in this study, quality-of-life issues -- lost productivity at work, limitations in everyday activities, and changes in overall health -- are examined. "It's what economists call intangibles, nonmedical costs," researcher K. Robin Yabroff, PhD, MBA, an epidemiologist with the National Cancer Institute, tells WebMD.
Improvements in early diagnosis and treatment have led to improved survival, and that trend is likely to continue, writes Yabroff. But with the aging baby boomer population, more and more people will be at various stages of cancer treatment and remission. How are they faring in their day-to-day life? That's the question she sought to answer.
She based her study on surveys completed by more than 7,000 adults -- including 1,800 cancer survivors and 5,500 adults with no cancer history. In the surveys, they provided details about their health, limitations in activities, employment status, sick days taken, and cancer history.
Among the questions they answered: Did they have back problems? Arthritis? Heart problems? High blood pressure? Weight problems? Depression? Did they smoke? Did they ever get a cancer diagnosis? How long ago? They reported limitations in usual activities such as everyday household chores and limitations in productivity and they rated their health.
Overall, cancer survivors had worse quality of life, less work productivity, and more health limitations compared with cancer-free people. They were less likely to be employed. If they had jobs, they took more sick days. Their working hours -- even the type of work they could do -- were limited. They rated their health as fair or poor. They needed help with everyday living. They also spent more days in bed.
Whether they were working or not -- whether retired or on medical leave -- the cancer survivors had many more days when they were not productive, she adds.
These losses are "substantial, even among those who have survived well beyond five years following diagnosis," she says. "Contrary to our expectations, long-term cancer survivors, even 11 or more years after diagnosis, had a significantly higher burden. ... These findings did not appear to be due to older age."
Fatigue, Swelling, Pain Last Many Years
Jerome Yates, MD, national vice-president for research at the American Cancer Society, was not involved in the study but offers his insights.
Breast cancer is a perfect example of these long-term "hidden" effects, he says.
"Even if a woman has a lumpectomy [rather than having a breast removed], surgery is involved. There is an incision and a scar, and that may always be painful," Yates tells WebMD. "If she has a lymph node removed, she will have swelling in her arms for years. Or she may have shoulder pain if she didn't get adequate rehabilitation after surgery."
Also, there's the stress, anger, and fear the cancer will come back.
"In the past, the attitude has been if you're cured of cancer then you shouldn't have long-term problems," Yates explains. "The reality is there are a variety of physical and emotional problems that can continue for years afterwards."
"This is a superb article...It points to the fact that we need to do more looking at late-effect problems of cancer survivors," says Yates.