Symptoms and symptom management in long-term cancer survivors

It is estimated that there are 13 million cancer survivors in the United States, and more than 65% of them are 5 or more years beyond their diagnosis. The majority are "cancer-free and free of cancer," although some survivors have late or long-term effects of treatment or develop second or secondary cancers. Late and long-term effects for survivors of childhood cancers have been well studied, but less is known about the "seasons of survivorship" for adult cancer survivors. Symptoms during diagnosis, treatment, and then extending through the first several years of survivorship were reported in more than half of a large and heterogeneous group of cancer survivors. The incidence of late and/or long-term symptoms and health problems of long-term cancer survivors is less well characterized. These persistent symptoms are related to survivors' cancer diagnosis and the treatment they received, as well as age and other comorbidities. Health-related quality of life generally is stable for many years, although some cancer survivors experience a significant drop in health-related quality of life years after treatment, although the etiology is not clear yet. This article provides an overview of the natural history of cancer survivorship ("The seasons of survivorship"), disease-specific toxicities, and changes in symptoms in cancer survivors over time. Several common symptoms are used as examples including pain, fatigue, and cognitive dysfunction.