The summer is upon us. I realize that most of my articles have focused on research conducted in the Northeast. My cousin Simona and her family in Los Angeles have made me aware that California is important too. I have always been a great fan of the Beach Boys and, listening to them the other day, I have decided to devote a series of articles to the scientists and the great work coming out of the West Coast, specifically California, focusing on Beach Boys music. I hope that these articles feel appropriate for our summer amusement and activities.
We begin today with a scientist who is a native of Los Angeles. If you listen to “California Dreamin’,” it suggests you would be safe and warm if you were in LA. Nowadays approximately 46% of men and 38% of women will get cancer at some point in their lives. And, thank God, most of them will be cured or do well. There was a time when the idea that there would be a discipline devoted to the study of survivorship in cancer would have been scorned. After all, cancer was a dread disease and most people either had severe comorbidities from it or simply died.
Time passed and progress in cancer screening, diagnosis and treatment has occurred. It is estimated that today there are 17 million cancer survivors in the U.S.
As a consequence, the world of oncology and cancer research has recognized the need to study and deal with the problems of these individuals. They may or will have had physical or psychological problems stemming from the cancer itself or from its management. There may also be an overlay of psychological problems—fatigue, pain, sleep issues, anxiety and depression. Obviously, other practical problems may also impair their quality of life, such as the financial residue of dealing with the medical consequences of the disease, issues arising from the return to work after a prolonged absence, and dealing with loved ones and caregivers. A great deal of attention is also focused on the long-term consequences of the cancer treatments, like lymphedema, cognitive impairment, damage to end-organs like the heart, hormonal imbalances and osteoporosis, fertility, sexual performance and proclivity, and fertility. Second malignancies are also important common long-term outcomes in cancer survivors.
And pervading all is the fear of cancer recurrence. Such issues differ for the pediatric/adolescent population in contrast to the adult/elderly population. The formal study and advocacy for cancer survivorship really has its origins in the mid-1980s when the side effects of chemotherapy drugs, the prominence of second malignancies in cancer survivors, and the increasing survival and cure rates for certain malignancies combined to bring about a realization that cancer survivorship as an entity existed. The NCI created an Office of Cancer Survivorship in 1992 in recognition of this trend and to direct research and service needs to this field.
Patricia (or Patti) Ganz was born and grew up in Los Angeles, specifically Beverly Hills, the daughter of a physician father and homemaker mother. Her father encouraged her to go into medicine. She did her undergraduate degree at Radcliffe and then returned to UCLA for medical school (one of three women in a class of 120). She trained in medical oncology at UCLA as well as palliative care, not a common pathway at that time. In 1986, she became a founding member of the National Coalition for Cancer Survivorship. She was soon recruited to the Jonsson Comprehensive Cancer Center as its director for population sciences and cancer control.
In the 1990s, she conducted numerous studies that focused on the quality of life of patients with breast cancer. These studies particularly addressed the psychosocial problems and needs faced by these women who were by then having significantly improved survival outcomes but were facing anxiety, depression and problems with their mentation, known as “chemo-brain.” Dr. Ganz’s studies, along with numerous collaborators, sought to determine the conditions which led to these problems and what could be done from a therapeutic point of view, i.e., which treatment regimens were most commonly associated with these outcomes. Thus, while survival remained as the most important determinant of treatment choice, Dr. Ganz and other survivorship investigators began to persuade oncologists that consideration should also be given to thinking about the long-term needs of cancer survivors and to choosing among treatment options with long-term quality of life as part of these decisions.
One such example is the use of Adriamycin (doxorubicin) in the adjuvant treatment of breast cancer. It is a powerful chemotherapeutic agent in this context, but it also causes significant cardiac toxicity. In a long-term survivor, it can lead to late cardiac problems, such as heart failure or coronary artery disease, and therefore alternatives to its use have been sought. And its use has gradually diminished in favor of other chemotherapy options that have less significant or dramatic long-term consequences.
Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York. Email: [email protected].
This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.
