ASPO Report Cancer Prevention after Cancer: Changing the Paradigm—a Report from the American Society of Preventive Oncology

The increasing number of cancer survivors has led to a growing need to reorient a focus in the care of these individuals on health promotion. In 2010, there were an estimated 12.5million cancer survivors, a figure projected to increase steadily over the next several years (1). Almost two-thirds of these survivors have lived with a cancer diagnosis for 5 or more years, and approximately 1.1 million cancer survivors will have lived with a cancer diagnosis for 25 or more years (2, 3). The numbers are even more impressive for childhood cancer survivors, where 10-year survival is approximately 75% (4). Because of earlier detection, improved diagnostic techniques, more effective treatment, and improved follow-up after treatment (3), more individuals will be living long-term with cancer; either cured of it or living with it as a chronic illness. Survivors are also older and aging as they survive longer. Not only are they at risk for recurrence and new primary cancers, they are also at risk for a number of comorbid health conditions, such as cardiovascular disease, obesity/diabetes, osteoporosis, unique pain syndromes, functional declines, and poor quality of life. These may be exacerbated by a cancer diagnosis and/or treatment, but, notably, many of these health conditions can be modified by positive behaviors or lifestyle interventions that have been found to reduce health risks in the general population and in cancer survivors. In other words, a successful completion of cancer treatment does not infer an end to the disease and its effects. For many cancer survivors, a new set of struggles begins posttreatment; consequently, there is a need to help control, and when possible, prevent cancer-related long-term and late occurring health outcomes. The transition from acute care to recovery represents a teachable moment in which health promotion interventions are aimed at reducing the risk of cancer recurrence and subsequent comorbid conditions, promoting early detection of secondary cancers, and improving quality of life can be implemented. The growing number of cancer survivors calls for a shift in the cancer control paradigm from a limited view that places survivorship as one part of a linear continuum to one that recognizes survivorship issues more broadly, including the importance of prevention and early detection of second malignancies, as well as, the possibility of having treatment for second malignancies (Fig. 1; refs. 4, 5).Within this newparadigm, targeting cancer survivors at all points along the cancer control continuum is a prominent research priority. The 2011 annual meeting of the American Society of Preventive Oncology (ASPO) held a survivorship special interest group (SIG) meeting to address the state of the cancer survivorship science on health promotion behaviors, examine knowledge gaps, and identify research directions to advance the field. Three crucial survivorship areas were discussed in this context: screening for second malignant neoplasms in adult childhood cancer survivors, smoking cessation among cancer survivors, and the role of energy balance in health of cancer survivors. This article summarizes those SIG meeting presentations and the recommended research directions for advancing the field.