Cancer Survivorship Research and Publications

CDC supports, designs, implements, and evaluates public health research to assess the needs of cancer survivors and their friends, family members, providers, and others. CDC, along with its public health partners, conducts research to address areas of survivorship and quality of life, some of which include—

• Coordination of care.
• Immediate and long-term effects of cancer and its treatment.
• Patient-provider communication.
• Health behaviors associated with cancer risk and health promotion, such as physical activity, nutrition, and tobacco use.
• Support services.
• Psychosocial and mental health needs.
• Fertility preservation.
• Economic burden of cancer survivorship, including medical expenditures and productivity loss.
• Health disparities.

What Does the Science Say?

Health Care Costs

• Cancer survivors report having higher medical costs than individuals without cancer, which may reduce their ability to obtain necessary medical care.¹
• Mental health problems presented higher health and economic burdens among younger and longer-term survivors than individuals without a cancer history.²
• Survivors who are within one year of their initial diagnosis reported spending less on mental health drugs and services, compared to survivors who were more than one year past their initial diagnosis.²
• The economic burden of cancer survivorship is substantial, resulting in excess health care expenditures and lost productivity costs compared with individuals without a history of cancer.³

Access to Care

Although access to and use of preventive care among cancer survivors is generally similar to or greater than individuals without a history of cancer, there are disparities for uninsured and publicly insured cancer survivors aged 18 to 64 years.⁴

Cancer Treatment

A decade of CDC-supported research focused on prostate cancer treatment has explored patient information-seeking behavior, caregiver and provider involvement in treatment decision making, and patient quality of life following treatment for low-risk prostate cancer.⁵

Physical and Mental Health Concerns and Quality of Life

• Compared with individuals without a cancer history, cancer survivors were more likely to screen positive for psychological distress and depression regardless of time since diagnosis.²
• Survivors who are within one year of their initial diagnosis may be more likely to use mental health prescription drugs.²
• Breast cancer survivors report concerns with memory, thinking, and attention after treatment, but few are talking to their doctors or getting help.⁶
• Older colorectal cancer survivors who exercise may have better physical and overall health-related quality of life.⁷

Survivorship Care Plans

• The most common challenge for primary care providers to implement survivorship care plan recommendations is insufficient knowledge of cancer survivors’ concerns.⁸
• Cancer survivors may find high value in personalized survivorship care plans, but the plans do not eliminate confusion regarding coordinating their follow-up care.⁹
• More work needs to be done to streamline processes that identify eligible patients and to develop and implement survivorship care plans for colon cancer survivors.¹⁰

Health Behavior Knowledge and Behaviors

• Pertaining to healthy eating, colorectal cancer survivors are most familiar with dietary recommendations to choose low-fat foods, but some colorectal cancer survivors report not being aware of recommendations to limit alcohol to no more than one drink a day for women and two drinks a day for men.¹¹
• Online resources provide helpful psychosocial and reproductive health information to young African American breast cancer survivors.¹²
• Cancer survivors are more likely to make positive than negative health behavior changes after cancer.¹³

Post-Treatment Surveillance

• African Americans are less likely to receive appropriate surveillance after colorectal cancer treatment.¹⁴
• Patients’ limited understanding about the importance of colorectal cancer surveillance and procedures may negatively affect compliance with recommendations among African-American colorectal cancer survivors.¹⁵

References

¹Guy GP, Jr., Yabroff KR, Ekwueme DU, Virgo KS, Han X, Banegas MP, Soni A, Zheng Z, Chawla N, Geiger AM. Health care expenditure burden among non-elderly cancer survivors, 2008–2012. American Journal of Preventive Medicine 2015;49(6):S489–S497.

²Li C, Forsythe L, Lerro C, Soni A. Mental health services utilization and expenditures associated with cancer survivorship in the United States. Journal of Cancer Survivorship 2015;9(1):50–58.

³Guy G., Ekwueme DU., Yabroff KR., Dowling E., Li C., Rodriguez J., de Moor J., Virgo K. Economic burden of cancer survivorship among adults in the United States. Journal of Clinical Oncology 2013,31(30):3749–3759.

⁴Yabroff KR, Short PF, Machlin S, Dowling E, Rozjabek H, Li C, McNeel T, Ekwueme DU, Virgo KS. Access to preventive health care for cancer survivors. American Journal of Preventive Medicine 2013;45(3):304–312.

⁵Hall IJ, Lee Smith J. Evolution of a CDC public health research agenda for low-risk prostate cancer. American Journal of Preventive Medicine 2015;49(6):S483–S488.

⁶Buchanan ND, Dasari S, Rodriguez JL, Lee Smith J, Hodgson ME, Weinberg CR, Sandler DP. Post-treatment neurocognition and psychosocial care among breast cancer survivors. American Journal of Preventive Medicine 2015;49(6):S498–S508.

⁷Rodriguez JL, Hawkins NA, Berkowitz Z, Li C. Factors associated with health-related quality of life among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6):S518-S527.

⁸Dulko D, Pace CM, Dittus KL, Sprague BL, Pollack LA, Hawkins NA, Geller BM. Barriers and facilitators to implementing cancer survivorship care plans. Oncology Nursing Forum 2013;40(6):575–580.

⁹Sprague BL, Dittus KL, Pace CM, Dulko D, Pollack LA, Hawkins NA, Geller BM. Patient satisfaction with breast and colorectal cancer survivorship care plans. Clinical Journal of Oncology Nursing 2013;17(3):266–272.

¹⁰Mayer DK, Gerstel A, Walton AL, Triglianos T, Sadiq TE, Hawkins NA, Davies JM. Implementing survivorship care plans for colon cancer survivors. Oncology Nursing Forum 2014;41(3):266–273.

¹¹Hawkins NA, Berkowitz Z, Rodriguez JL. Awareness of dietary and alcohol guidelines among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6, Supplement 5):S509–S517.

¹²Johnson-Turbes A, Schlueter D, Moore AR, Buchanan ND, Fairley TL. Evaluation of a Web-based program for African American young breast cancer survivors. American Journal of Preventive Medicine 2015;49(6):S543–S549.

¹³Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD. Health-related behavior change after cancer: results of the American Cancer Society’s studies of cancer survivors (SCS). Journal of Cancer Survivorship 2010;4(1):20–32.

¹⁴Le D, Holt CL, Pisu M, Brown-Galvan A, Fairley TL, Lee Smith J, White A, Hall IJ, Oster RA, Martin MY. The role of social support in posttreatment surveillance among African American survivors of colorectal cancer. Journal of Psychosocial Oncology 2014;32(3):245–263.

¹⁵Pisu M, Holt CL, Brown-Galvan A, Fairley T, Smith JL, White A, Hall IJ, Oster RA, Martin MY. Surveillance instructions and knowledge among African American colorectal cancer survivors. Journal of Oncology Practice 2014;10(2):e45–e50.